WHA64/2011/REC/1
WORLD HEALTH ORGANIZATION
SIXTY-FOURTH
WORLD HEALTH ASSEMBLY
GENEVA, 16–24 MAY 2011
RESOLUTIONS AND DECISIONS
ANNEXES
GENEVA
2011
ABBREVIATIONS
Abbreviations used in WHO documentation include the following:
ACHR
ASEAN
CEB
CIOMS
FAO
IAEA
IARC
ICAO
IFAD
ILO
IMF
IMO
INCB
ITU
OECD
OIE
– Office International des
Epizooties
PAHO
– Pan American Health
Organization
UNAIDS – Joint United Nations Programme
on HIV/AIDS
UNCTAD – United Nations Conference on
Trade and Development
UNDCP – United Nations International Drug
Control Programme
UNDP
– United Nations Development
Programme
UNEP
– United Nations Environment
Programme
UNESCO – United Nations Educational,
Scientific and Cultural
Organization
UNFPA – United Nations Population Fund
UNHCR – Office of the United Nations High
Commissioner for Refugees
UNICEF – United Nations Children’s Fund
UNIDO – United Nations Industrial
Development Organization
UNRWA – United Nations Relief and Works
Agency for Palestine Refugees in
the Near East
WFP
– World Food Programme
WIPO
– World Intellectual Property
Organization
WMO
– World Meteorological
Organization
WTO
– World Trade Organization
– Advisory Committee on Health
Research
– Association of Southeast Asian
Nations
– United Nations System Chief
Executives Board for
Coordination (formerly ACC)
– Council for International
Organizations of Medical
Sciences
– Food and Agriculture
Organization of the United
Nations
– International Atomic Energy
Agency
– International Agency for Research
on Cancer
– International Civil Aviation
Organization
– International Fund for
Agricultural Development
– International Labour Organization
(Office)
– International Monetary Fund
– International Maritime
Organization
– International Narcotics Control
Board
– International Telecommunication
Union
– Organisation for Economic
Co-operation and Development
_______________
The designations employed and the presentation of the material in this volume do not imply the
expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning
the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its
frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers
countries, territories, cities or areas.
- ii -
PREFACE
The Sixty-fourth World Health Assembly was held at the Palais des Nations, Geneva, from
16 to 24 May 2011, in accordance with the decision of the Executive Board at its 127th session.
_______________
- iii -
CONTENTS
Page
Preface .............................................................................................................................................
iii
Agenda ............................................................................................................................................
ix
List of documents ............................................................................................................................
xiii
Officers of the Health Assembly and membership of its committees .............................................
xix
RESOLUTIONS AND DECISIONS
Resolutions
WHA64.1
Implementation of the International Health Regulations (2005) ......................
1
WHA64.2
WHO reform.....................................................................................................
2
WHA64.3
Appropriation resolution for the financial period 2012–2013 ..........................
2
WHA64.4
Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan ...................................................
5
Pandemic influenza preparedness: sharing of influenza viruses and access
to vaccines and other benefits ..........................................................................
8
WHA64.6
Health workforce strengthening .......................................................................
9
WHA64.7
Strengthening nursing and midwifery ..............................................................
13
WHA64.8
Strengthening national policy dialogue to build more robust health policies,
strategies and plans ...........................................................................................
16
WHA64.9
Sustainable health financing structures and universal coverage ......................
18
WHA64.10
Strengthening national health emergency and disaster management
capacities and resilience of health systems ......................................................
21
WHA64.5
WHA64.11
Preparations for the High-level Meeting of the United Nations General
Assembly on the Prevention and Control of Non-communicable Diseases,
following on the Moscow Conference .............................................................
-v-
Page
WHA64.12
WHO’s role in the follow-up to the United Nations High-level Plenary
Meeting of the General Assembly on the Millennium Development Goals
(New York, September 2010) ...........................................................................
26
WHA64.13
Working towards the reduction of perinatal and neonatal mortality ................
28
WHA64.14
Global health sector strategy on HIV/AIDS, 2011–2015 .................................
30
WHA64.15
Cholera: mechanism for control and prevention...............................................
31
WHA64.16
Eradication of dracunculiasis ............................................................................
34
WHA64.17
Malaria ..............................................................................................................
35
WHA64.18
Unaudited interim financial report on the accounts of WHO
for the year 2010 ...............................................................................................
39
Status of collection of assessed contributions, including Member States
in arrears in the payment of their contributions to an extent that would
justify invoking Article 7 of the Constitution ...................................................
39
WHA64.20
Special arrangements for settlement of arrears .................................................
40
WHA64.21
Scale of assessments for 2012–2013 ................................................................
41
WHA64.22
Amendments to the Financial Regulations .......................................................
45
WHA64.23
Appointment of the External Auditor ...............................................................
46
WHA64.24
Drinking-water, sanitation and health...............................................................
46
WHA64.25
Salaries of staff in ungraded posts and of the Director-General .......................
50
WHA64.26
International Agency for Research on Cancer: amendments to Statute ...........
51
WHA64.27
Child injury prevention .....................................................................................
51
WHA64.28
Youth and health risks ......................................................................................
55
WHA64(1)
Composition of the Committee on Credentials.................................................
59
WHA64(2)
Election of officers of the Sixty-fourth World Health Assembly .....................
59
WHA64(3)
Election of officers of the main committees .....................................................
59
WHA64(4)
Establishment of the General Committee .........................................................
60
WHA64(5)
Adoption of the agenda.....................................................................................
60
WHA64(6)
Verification of credentials ................................................................................
60
WHA64.19
Decisions
- vi -
Page
WHA64(7)
WHA64(8)
WHA64(9)
WHA64(10)
WHA64(11)
Election of Members entitled to designate a person to serve on the
Executive Board ...............................................................................................
67
United Nations Joint Staff Pension Fund: appointment of representatives to
the WHO Staff Pension Committee .................................................................
67
Selection of the country in which the Sixty-fifth World Health Assembly
would be held ...................................................................................................
67
Substandard/spurious/falsely-labelled/falsified/counterfeit
medical products...............................................................................................
67
Smallpox eradication: destruction of variola virus stocks ................................
68
ANNEXES
1.
Recommendations contained in the final report of the Review Committee on
the Functioning of the International Health Regulations (2005) in relation to
Pandemic (H1N1) 2009 ........................................................................................................
71
Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and
access to vaccines and other benefits ....................................................................................
79
3.
The Moscow Declaration ......................................................................................................
121
4.
Global health sector strategy on HIV/AIDS, 2011–2015 .....................................................
127
5.
Text of the amended Financial Regulations of the World Health Organization ...................
157
6.
Financial and administrative implications for the Secretariat of resolutions adopted by
the Health Assembly .............................................................................................................
158
2.
_______________
- vii -
AGENDA1
PLENARY
1.
Opening of the Health Assembly
1.1
Appointment of the Committee on Credentials
1.2
Election of the President
1.3
Election of the five Vice-Presidents, the Chairmen of the main committees, and
establishment of the General Committee
1.4
Adoption of the agenda and allocation of items to the main committees
2.
Report of the Executive Board on its 127th and 128th sessions
3.
Address by Dr Margaret Chan, Director-General
4.
Invited speaker
5.
[Deleted]
6.
Executive Board: election
7.
Awards
8.
Reports of the main committees
9.
Closure of the Health Assembly
COMMITTEE A
10.
Opening of the Committee2
11.
The future of financing for WHO
12.
Programme and budget matters
12.1 Implementation of Programme budget 2010–2011: interim report
1
Adopted at the second plenary meeting.
2
Including election of Vice-Chairmen and Rapporteur.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
12.2 Medium-term strategic plan 2008–2013: interim assessment
12.3 Medium-term strategic plan 2008–2013 and Proposed programme budget 2012–2013
13.
Technical and health matters
13.1 Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and
other benefits
13.2 Implementation of the International Health Regulations (2005)
13.3 Health-related Millennium Development Goals
WHO’s role in the follow-up to the high-level plenary meeting of the sixty-fifth session
of the United Nations General Assembly on the review of the Millennium Development
Goals (September 2010)
13.4 Health system strengthening
13.5 Global immunization vision and strategy
13.6 Draft WHO HIV/AIDS strategy 2011–2015
13.7 Substandard/spurious/falsely-labelled/falsified/counterfeit medical products
13.8 Smallpox eradication: destruction of variola virus stocks
13.9 Cholera: mechanism for control and prevention
13.10 Malaria
13.11 Eradication of dracunculiasis
13.12 Prevention and control of noncommunicable diseases
WHO’s role in the preparation, implementation and follow-up to the high-level meeting
of the United Nations General Assembly on the prevention and control of
non-communicable diseases (September 2011)
13.13 [Transferred to Committee B]
13.14 [Transferred to Committee B]
13.15 [Transferred to Committee B]
13.16 [Transferred to Committee B]
13.17 [Transferred to Committee B]
-x-
AGENDA
COMMITTEE B
14.
Opening of the Committee1
15.
Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the
occupied Syrian Golan
16.
Audit and oversight matters
Report of the Internal Auditor
17.
Financial matters
17.1 Unaudited interim financial report on the accounts of WHO for the year 2010
17.2 Interim report of the External Auditor
17.3 Status of collection of assessed contributions, including Member States in arrears in the
payment of their contributions to an extent that would justify invoking Article 7 of the
Constitution
17.4 Special arrangements for settlement of arrears
17.5 Scale of assessments for 2012–2013
17.6 [Deleted]
17.7 Amendments to the Financial Regulations and Financial Rules
17.8 Appointment of the External Auditor
18.
Staffing matters
18.1 Human resources: annual report
18.2 Report of the International Civil Service Commission
18.3 Amendments to the Staff Regulations and Staff Rules
18.4 Report of the United Nations Joint Staff Pension Board
18.5 Appointment of representatives to the WHO Staff Pension Committee
18.6 Interim progress report of the Working Group on the Election of the Director-General of
the World Health Organization
19.
Collaboration within the United Nations system and with other intergovernmental organizations
20.
International Agency for Research on Cancer: amendments to Statute
1
Including election of Vice-Chairmen and Rapporteur.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
13.
Technical and health matters
13.13 Infant and young child nutrition: implementation plan
13.14 Child injury prevention
13.15 Strategies for the safe management of drinking-water for human consumption
13.16 Youth and health risks
13.17 Progress reports
A.
Poliomyelitis: mechanism for management of potential risks to eradication
(resolution WHA61.1)
B.
Onchocerciasis control through ivermectin distribution (resolution WHA47.32)
C.
Climate change and health (resolutions WHA61.19 and EB124.R5)
D.
Improvement of health through sound management of obsolete pesticides and other
obsolete chemicals (resolution WHA63.26)
E.
Improvement of health through safe and environmentally sound waste management
(resolution WHA63.25)
F.
Working towards universal coverage of maternal, newborn and child health
interventions (resolution WHA58.31)
G.
Female genital mutilation (resolution WHA61.16)
H.
Strategy for integrating gender analysis and actions into the work of WHO
(resolution WHA60.25)
I.
Progress in the rational use of medicines (resolution WHA60.16)
J.
Implementation by WHO of the recommendations of the Global Task Team on
Improving AIDS Coordination among Multilateral Institutions and International
Donors (resolution WHA59.12)
–––––––––––––––
- xii -
LIST OF DOCUMENTS
A64/1 Rev.1
Agenda1
A64/2
Report of the Executive Board on its 127th and 128th sessions
A64/3
Address by Dr Margaret Chan, Director-General to the Sixty-fourth
World Health Assembly
A64/4
The future of financing for WHO
World Health Organization: reforms for a healthy future
A64/4 Add.1
Report on financial and administrative implications for the Secretariat of
resolutions proposed for adoption by the Executive Board or Health
Assembly2
A64/5
Implementation of Programme budget 2010–2011: interim report
A64/6
Medium-term strategic plan 2008–2013: interim assessment
A64/7 and
A64/7 Add.1
Medium-term strategic plan 2008–2013 and Proposed programme budget
2012–2013
A64/7 Add.2
Appropriation resolution for the financial period 2012–2013
A64/8 and
A64/8 Corr.1
Pandemic influenza preparedness: sharing of influenza viruses and access
to vaccines and other benefits3
A64/8 Add.1
Report on financial and administrative implications for the Secretariat of
resolutions proposed for adoption by the Executive Board or Health
Assembly2
A64/9
Implementation of the International Health Regulations (2005)
A64/10 and
A64/10 Add.1
Implementation of the International Health Regulations (2005): report of
the Review Committee on the Functioning of the International Health
Regulations (2005) in relation to Pandemic (H1N1) 20094
1
See page ix.
2
See Annex 6.
3
See Annex 2.
4
See Annex 1.
- xiii -
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
A64/10 Add.2
Report on financial and administrative implications for the Secretariat of
resolutions proposed for adoption by the Executive Board or Health
Assembly1
A64/11
Health-related Millennium Development Goals
A64/11 Add.1
Health-related Millennium Development Goals: Commission on
Information and Accountability for Women’s and Children’s Health
A64/12
Health system strengthening: improving support to policy dialogue
around national health policies, strategies and plans
A64/13
Health system strengthening: current trends and challenges
A64/14
Global immunization vision and strategy
A64/15
Draft WHO HIV strategy 2011–20152
A64/16
Substandard/Spurious/Falsely-Labelled/Falsified/Counterfeit Medical
Products
A64/17
Smallpox eradication: destruction of variola virus stocks
A64/18
Cholera: mechanism for control and prevention
A64/19
Malaria
A64/20
Eradication of dracunculiasis
A64/21
Prevention and control of noncommunicable diseases
A64/21 Add.1
Report on financial and administrative implications for the Secretariat of
resolutions proposed for adoption by the Executive Board or Health
Assembly1
A64/22
Maternal, infant and young child nutrition: implementation plan
A64/23
Child injury prevention
A64/24
Strategies for the safe management of drinking-water for human
consumption
A64/25
Youth and health risks
A64/26
Progress reports
1
See Annex 6.
2
See Annex 4 for the strategy, as amended.
- xiv -
LIST OF DOCUMENTS
A64/27
Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan
A64/28
Report of the Internal Auditor
A64/29
Unaudited Interim Financial Report for the year 2010
A64/29 Add.1
Annex: voluntary contributions by fund and by donor for the year ended
31 December 2010
A64/30
Interim Report of the External Auditor
A64/31
Status of collection of assessed contributions, including Member States in
arrears in the payment of their contributions to an extent that would
justify invoking Article 7 of the Constitution
A64/32
Special arrangements for settlement of arrears: Ukraine
A64/33
Scale of assessments for 2012–2013
A64/34
Amendments to the Financial Regulations1 Implementation of the
International Public Sector Accounting Standards, frequency of external
audits and the term of office of the External Auditor
A64/35 and
A64/35 Corr.1
Appointment of the External Auditor
A64/36
Human resources: annual report
A64/37
Report of the International Civil Service Commission
A64/38
Amendments to the Staff Regulations and Staff Rules
A64/39
Report of the United Nations Joint Staff Pension Board
A64/40
Appointment of representatives to the WHO Staff Pension Committee
A64/41
Interim progress report of the Working Group on the Election of the
Director-General of the World Health Organization
A64/42
Collaboration within the United Nations system and with other
intergovernmental organizations
A64/43
International Agency for Research on Cancer: amendments to Statute
A64/44
Awards. Amendments to the Statutes of the Dr LEE Jong-wook Memorial
Prize for Public Health
1
See Annex 5.
- xv -
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
A64/45
Implementation of Programme budget 2010–2011: interim report.
First report of the Programme, Budget and Administration Committee
of the Executive Board to the Sixty-fourth World Health Assembly
A64/46
Medium-term strategic plan 2008–2013: interim assessment.
Third report of the Programme, Budget and Administration Committee of
the Executive Board to the Sixty-fourth World Health Assembly
A64/47
Medium-term strategic plan 2008–2013 and Proposed programme budget
2012–2013. Fourth report of the Programme, Budget and Administration
Committee of the Executive Board to the Sixty-fourth World Health
Assembly
A64/48
Report of the Internal Auditor. Sixth report of the Programme, Budget
and Administration Committee of the Executive Board to the Sixty-fourth
World Health Assembly
A64/49 and
A64/49 Corr.1
Unaudited interim financial report on the accounts of WHO for the year
2010. Second report of the Programme, Budget and Administration
Committee of the Executive Board to the Sixty-fourth World Health
Assembly
A64/50
Interim report of the External Auditor. Seventh report of the Programme,
Budget and Administration Committee of the Executive Board to the
Sixty-fourth World Health Assembly
A64/51
Status of collection of assessed contributions, including Member States in
arrears in the payment of their contributions to an extent that would
justify invoking Article 7 of the Constitution and Special arrangements
for settlement of arrears: Ukraine. Fifth report of the Programme, Budget
and Administration Committee of the Executive Board to the Sixty-fourth
World Health Assembly
A64/52
Committee on Credentials
A64/53
First report of Committee A
A64/54
Second report of Committee A
A64/55
First report of Committee B
A64/56
Election of Members entitled to designate a person to serve on the
Executive Board
A64/57
Third report of Committee A
A64/58
Second report of Committee B
A64/59
Fourth report of Committee A
- xvi -
LIST OF DOCUMENTS
A64/60
Third report of Committee B
A64/61
Fifth report of Committee A
A64/62
Fourth report of Committee B
A64/63
Sixth report of Committee A
A64/64
Seventh report of Committee A
Information documents
A64/INF.DOC./1
Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan (report by the Ministry of
Health of the Syrian Arab Republic)
A64/INF.DOC./2
Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan (report by the Permanent
Observer of Palestine to the United Nations and Other
International Organizations at Geneva)
A64/INF.DOC./3
Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan (report of the Director of
Health, UNRWA, for the year 2010)
A64/INF.DOC./4
Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan (report by the Ministry of
Health of Israel)
A64/INF.DOC./5
The future of financing for WHO. Reforms for a healthy future:
development plan
Diverse documents
A64/DIV/1 Rev.1
List of delegates and other participants
A64/DIV/2
Guide for delegates to the World Health Assembly
A64/DIV/3
Decisions and list of resolutions
A64/DIV/4
List of documents
A64/DIV/5
Address by Her Excellency Sheikh Hasina, Prime Minister of the
Government of Bangladesh, to the Sixty-fourth World Health Assembly
A64/DIV/6
Address by Mr Bill Gates to the Sixty-fourth World Health Assembly
_______________
- xvii -
OFFICERS OF THE HEALTH ASSEMBLY AND
MEMBERSHIP OF ITS COMMITTEES
United Kingdom of Great Britain and Northern
Ireland, Micronesia (Federated States of),
Paraguay, Russian Federation and United
States of America.
President
Dr Christos PATSALIDES (Cyprus)
Vice-Presidents
Professor C.O. ONYEBUCHI CHUKWU
(Nigeria)
Mr RI Jang Gon (Democratic People’s
Republic of Korea)
Dr Enrique T. ONA (Philippines)
Dr Mohammad Hussein NICKNAM
(Islamic Republic of Iran)
Mrs Therese BAPTISTE-CORNELIS
(Trinidad and Tobago)
Chairman: Dr Christos PATSALIDES (Cyprus)
Secretary: Dr Margaret CHAN, DirectorGeneral
MAIN COMMITTEES
Under Rule 33 of the Rules of Procedure of
the World Health Assembly, each delegation is
entitled to be represented on each main
committee by one of its members.
Secretary
Dr Margaret CHAN, Director-General
Committee A
Committee on Credentials
Chairman: Dr Walid AMMAR (Lebanon)
Vice-Chairmen: Dr Henry MADZORERA
(Zimbabwe) and Mr Nandi GLASSIE
(Cook Islands)
Rapporteur: Dr Mast KULZHANOV
(Kazakhstan)
Secretary: Dr Maged YOUNES, Director,
Food Safety, Zoonoses and Foodborne
Diseases
The Committee on Credentials was
composed of delegates of the following
Member States: Barbados, Costa Rica, Fiji,
Gabon, Guinea Bissau, Latvia, Malawi,
Maldives, New Zealand, Pakistan, Serbia,
Uzbekistan.
Chairman: Dr K. WOODS (New Zealand)
Vice-Chairman: Professor D. MPHANDE
(Malawi)
Secretary: Mr Xavier DANEY, Senior Legal
Officer
Committee B
Chairman: Dr Maria Teresa VALENZUELA
(Chile)
Vice-Chairman: Dr Ante-Zvonimir GOLEM
(Croatia) and Mr Zangley DUKPA
(Bhutan)
Rapporteur: Dr T. Tuitama Leao TUITAMA
(Samoa)
Secretary: Dr Manuel DAYRIT, Director,
Human Resources for Health
General Committee
The General Committee was composed of
the President and Vice-Presidents of the Health
Assembly and the Chairmen of the main
committees, together with delegates of the
following Member States: Albania, Botswana,
China, Cuba, Egypt, Eritrea, Ethiopia,
France, Gambia, Guinea, Hungary, India,
______________
- xix -
RESOLUTIONS
WHA64.1
Implementation of the International Health Regulations (2005)1
The Sixty-fourth World Health Assembly,
Recognizing the establishment of a Review Committee as provided for in Chapter III of Part IX
of the International Health Regulations (2005), and the remit to review the functioning of the
International Health Regulations (2005) as well as the response to pandemic (H1N1) 2009, in
accordance with the objectives, scope, methodology and timeline accepted by the Executive Board at
its 126th session;2
Commending the successful conclusion of the work of the Review Committee on the
Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009, the
leadership of its Chair, the dedication of its distinguished members, and the submission of its final
report to the Director-General for transmittal to the Sixty-fourth World Health Assembly;
Having considered the final report of the Review Committee on the Functioning of the
International Health Regulations (2005) in relation to Pandemic (H1N1) 2009,3
1.
URGES Member States to support the implementation of the recommendations contained in the
final report of the Review Committee on the Functioning of the International Health Regulations
(2005) in relation to Pandemic (H1N1) 2009;4
2.
REQUESTS the Director-General:
(1) to present an update to the Sixty-sixth World Health Assembly, through the Executive
Board, on progress made in taking forward the recommendations of the Review Committee on
the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1)
2009;
(2) to provide technical support to Member States in implementing the recommendations of
the Review Committee on the Functioning of the International Health Regulations (2005) in
relation to Pandemic (H1N1) 2009.
(Ninth plenary meeting, 20 May 2011 –
Committee A, first report)
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
See document EB126/2010/REC/2, summary record of the second meeting, section 2.
3
See document A64/10.
4
See Annex 1 for the recommendations made by the Review Committee on the Functioning of the International
Health Regulations (2005) in relation to Pandemic (H1N1) 2009.
-1-
2
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
WHA64.2
WHO reform1
The Sixty-fourth World Health Assembly,
Having considered the report by the Director-General entitled World Health Organization:
reforms for a healthy future,2
1.
ENDORSES the agenda for reform as set out in the Director-General’s report;
2.
URGES Member States to support the implementation of the reform programme;
3.
REQUESTS the Executive Board to establish an appropriate process to examine the issues
related to WHO’s governance identified in the report;
4.
REQUESTS the Director-General:
(1) to present a detailed concept paper for the November 2012 World Health Forum, setting
out objectives, numbers of participants, format and costs, to the Executive Board at its
130th session in January 2012;
(2) in consultation with Member States, to develop an approach to independent evaluation,
and to present a first report on the independent evaluation of the work of WHO to the Sixty-fifth
World Health Assembly in May 2012;
(3) to present an update of progress to the Sixty-fifth World Health Assembly, through the
Executive Board.
(Ninth plenary meeting, 20 May 2011 –
Committee A, second report)
WHA64.3
Appropriation resolution for the financial period 2012–2013
The Sixty-fourth World Health Assembly,
1.
WELCOMES the total effective budget3 under all sources of funds, that is, assessed and
voluntary contributions, of US$ 3 958 979 000, presented in three segments:
Programme budget segment
Base programmes
Special programmes and collaborative arrangements
Outbreak and crisis response
Total effective budget
US$
2 626 762 000
863 533 000
468 684 000
3 958 979 000
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Documents A64/4 and A64/INF.DOC./5.
3
See documents A64/7, A64/7 Add.1 and A64/47.
RESOLUTIONS AND DECISIONS
3
2.
RESOLVES to appropriate for the financial period 2012–2013 an amount of US$ 1 038 840 000,
financed by net assessments on Members of US$ 928 840 000, estimated Member States’ non-assessed
income of US$ 15 000 000 if available, and transfer to the Tax Equalization Fund of US$ 95 000 000, as
shown below:
Appropriation
section
1
Purpose of appropriation
Appropriations
financed by net
assessments and
Member States’ nonassessed income (US$)
To reduce the health, social and economic burden of
communicable diseases
79 186 000
2
To combat HIV/AIDS, tuberculosis and malaria
45 634 000
3
To prevent and reduce disease, disability and
premature death from chronic noncommunicable
diseases, mental disorders, violence and injuries and
visual impairment
44 809 000
To reduce morbidity and mortality and improve
health during key stages of life, including pregnancy,
childbirth, the neonatal period, childhood and
adolescence, and improve sexual and reproductive
health and promote active and healthy ageing for all
individuals
55 754 000
To reduce the health consequences of emergencies,
disasters, crises and conflicts, and minimize their
social and economic impact
18 568 000
To promote health and development, and prevent or
reduce risk factors for health conditions associated
with use of tobacco, alcohol, drugs and other
psychoactive substances, unhealthy diets, physical
inactivity and unsafe sex
37 731 000
To address the underlying social and economic
determinants of health through policies and
programmes that enhance health equity and integrate
pro-poor, gender-responsive, and human rights-based
approaches
18 753 000
To promote a healthier environment, intensify
primary prevention and influence public policies in
all sectors so as to address the root causes of
environmental threats to health
32 507 000
To improve nutrition, food safety and food security,
throughout the life-course, and in support of public
health and sustainable development
22 359 000
To improve health services through better
governance, financing, staffing and management,
informed by reliable and accessible evidence and
research
145 421 000
To ensure improved access, quality and use of
medical products and technologies
30 751 000
4
5
6
7
8
9
10
11
4
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
12
13
To provide leadership, strengthen governance and
foster partnership and collaboration with countries,
the United Nations system, and other stakeholders in
order to fulfil the mandate of WHO in advancing the
global health agenda as set out in the Eleventh
General Programme of Work
202 410 000
To develop and sustain WHO as a flexible, learning
organization, enabling it to carry out its mandate
more efficiently and effectively
209 957 000
Subtotal
943 840 000
Transfer to Tax Equalization Fund
95 000 000
Total
3.
1 038 840 000
FURTHER RESOLVES that:
(1) notwithstanding the provisions of Financial Regulation 4.3, the Director-General is
authorized to make transfers between the appropriation sections up to an amount not exceeding
10% of the amount appropriated for the section from which the transfer is made; the expenditure
resulting from any such transfers shall be reported in the financial report for the financial period
2012–2013;
(2) amounts not exceeding the appropriations voted under paragraph 2 shall be available for
the payment of commitments incurred during the financial period 1 January 2012 to
31 December 2013 in accordance with the provisions of the Financial Regulations;
notwithstanding the provisions of the present paragraph, the Director-General shall limit the
commitments to be incurred during the financial period 2012–2013 to sections 1 to 13;
(3) the amount of the contribution to be paid by individual Members shall be reduced by the
sum standing to their credit in the Tax Equalization Fund; that reduction shall be adjusted in the
case of those Members that require staff members to pay income taxes on their WHO
emoluments, taxes which the Organization reimburses to said staff members; the amount of
such tax reimbursements is estimated at US$ 20 578 300, resulting in a total assessment on
Members of US$ 949 218 300;
4.
DECIDES that the Working Capital Fund shall be maintained at its existing level of
US$ 31 000 000;
5.
RECOGNIZES that the voluntary contributions required to meet the portion of the effective
working budget not financed through net assessments on Members are US$ 3 015 139 000.
(Ninth plenary meeting, 20 May 2011 –
Committee A, second report)
RESOLUTIONS AND DECISIONS
WHA64.4
5
Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan1
The Sixty-fourth World Health Assembly,
Mindful of the basic principle established in the Constitution of WHO, which affirms that the
health of all peoples is fundamental to the attainment of peace and security;
Recalling all its previous resolutions on health conditions in the occupied Palestinian territory
and other Arab occupied territories;
Recalling resolution EB124.R4, adopted by the Executive Board at its 124th session, on the
grave health situation caused by Israeli military operations in the occupied Palestinian territory,
particularly in the occupied Gaza Strip;
Taking note of the report of the Director-General on the health conditions in the occupied
Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan;2
Noting with deep concern the findings in the report of the Director-General on the specialized
health mission to the Gaza Strip;
Stressing the essential role of UNRWA in providing crucial health and education services in the
occupied Palestinian territory, particularly in addressing the emergency needs in the Gaza Strip;
Expressing its concern at the deterioration of economic and health conditions as well as the
humanitarian crisis resulting from the continued occupation and the severe restrictions imposed by
Israel, the occupying power;
Expressing its deep concern also at the health crisis and rising levels of food insecurity in the
occupied Palestinian territory, particularly in the Gaza Strip;
Affirming the need to guarantee universal coverage of health services and to preserve the
functions of the public health services in the occupied Palestinian territory;
Recognizing that the acute shortage of financial and medical resources in the Palestinian
Ministry of Health, which is responsible for running and financing public health services, jeopardizes
the access of the Palestinian population to curative and preventive services;
Affirming the right of Palestinian patients and medical staff to have access to the Palestinian
health institutions in occupied east Jerusalem;
Deploring the incidents involving lack of respect and protection for Palestinian ambulances and
medical personnel by the Israeli army, which have led to casualties among Palestinian medical
personnel, as well as the restrictions on their movements imposed by Israel, the occupying power, in
violation of international humanitarian law;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Document WHA64/27.
6
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Affirming that the blockade is continuing and that the crossing points are not entirely and
definitely opened, meaning that the crisis and suffering that started before the Israeli attack on the
Gaza Strip are continuing, hindering the efforts of the Palestinian Ministry of Health to reconstruct the
establishments destroyed by the Israeli military operations by the end of 2008 and in 2009;
Expressing deep concern at the grave implications of the wall on the accessibility and quality of
medical services received by the Palestinian population in the occupied Palestinian territory, including
east Jerusalem;
Expressing deep concern also at the serious implications for pregnant women and patients of the
restrictions on movement imposed by Israel on Palestinian ambulances and medical personnel,
1.
DEMANDS that Israel, the occupying power:
(1) immediately put an end to the closure of the occupied Palestinian territory, particularly
the closure of the crossing points of the occupied Gaza Strip that is causing the serious shortage
of medicines and medical supplies therein, and comply in this regard with the provisions of the
Israeli Palestinian Agreement on Movement and Access of November 2005;
(2) abandon its policies and measures that have led to the prevailing dire health conditions
and severe food and fuel shortages in the Gaza Strip;
(3) comply with the Advisory Opinion rendered on 9 July 2004 by the International Court of
Justice on the wall which, inter alia, has grave implications for the accessibility and quality of
medical services received by the Palestinian population in the occupied Palestinian territory,
including east Jerusalem;
(4) facilitate the access of Palestinian patients and medical staff to the Palestinian health
institutions in occupied east Jerusalem and abroad;
(5) ensure unhindered and safe passage for Palestinian ambulances as well as respect and
protection of medical personnel, in compliance with international humanitarian law;
(6) improve the living and medical conditions of Palestinian detainees, particularly children,
women and patients, and provide the necessary medical treatment to the detainees, whose
serious medical conditions are worsening every day;
(7) facilitate the transit and entry of medicine and medical equipment to the occupied
Palestinian territory;
(8) assume its responsibility with regard to the humanitarian needs of the Palestinian people
and their daily access to humanitarian aid, including food and medicine, in compliance with
international humanitarian law;
(9) halt immediately all its practices, policies and plans, including its policy of closure, that
seriously affect the health conditions of civilians under occupation;
(10) respect and facilitate the mandate and work of UNRWA and other international
organizations, and ensure the free movement of their staff and aid supplies;
RESOLUTIONS AND DECISIONS
2.
7
URGES Member States and intergovernmental and nongovernmental organizations:
(1) to help overcome the health crisis in the occupied Palestinian territory by providing
assistance to the Palestinian people;
(2) to help meet urgent health and humanitarian needs, as well as the important health-related
needs for the medium and long term, identified in the report of the Director-General on the
specialized health mission to the Gaza Strip;1
(3) to call upon the international community to exert pressure on the Government of Israel to
lift the siege imposed on the occupied Gaza Strip in order to avoid a serious exacerbation of the
humanitarian crisis therein and to help lift the restrictions and obstacles imposed on the
Palestinian people including the free movement of people and medical staff in the occupied
Palestinian territory, and to bring Israel to respect its legal and moral responsibilities and ensure
the full enjoyment of basic human rights for civilian populations in the occupied Palestinian
territory, particularly in east Jerusalem;
(4) to remind Israel, the occupying power, to abide by the Fourth Geneva Convention relative
to the Protection of Civilian Persons in Time of War (1949), which is applicable to the occupied
Palestinian territory including east Jerusalem;
(5) to call upon all international human rights organizations to intervene on an urgent and
immediate basis vis-à-vis the occupying power, Israel, and compel it to provide adequate
medical treatment to Palestinian prisoners and detainees, who are suffering from serious
medical conditions that are worsening every day, and urges civil society organizations to
exercise pressure on the occupying power, Israel, to save the lives of detainees and ensure the
immediate release of critical cases and to provide them with external treatment, and to allow
Palestinian women prisoners to receive maternity care services and medical follow-up during
pregnancy, delivery and postpartum care, and to allow them to give birth in healthy and
humanitarian conditions in the presence of their relatives and family members and immediately
to release all children detained in Israeli prisons;
(6) to support and assist the Palestinian Ministry of Health in carrying out its duties,
including running and financing public health services;
(7) to provide financial and technical support to the Palestinian public health and veterinary
services;
3.
EXPRESSES deep appreciation to the international donor community for their support of the
Palestinian people in different fields, and urges donor countries and international health organizations
to continue their efforts to ensure the provision of necessary political and financial support to enable
the implementation of the 2008–2010 health plan of the Palestinian Authority and to create a suitable
political environment to implement the plan with a view to putting an end to the occupation and
establishing the state of Palestine as proposed by the Government of Palestine, which is working
seriously to create the proper conditions for its implementation;
4.
EXPRESSES its deep appreciation to the Director-General for her efforts to provide necessary
assistance to the Palestinian people in the occupied Palestinian territory, including east Jerusalem, and
to the Syrian population in the occupied Syrian Golan;
1
Document A62/24 Add.1.
8
5.
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
REQUESTS the Director-General:
(1) to provide support to the Palestinian health and veterinary services including capacity
building;
(2) to submit a fact-finding report on the health and economic situation in the occupied
Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan;
(3) to support the establishment of medical facilities and provide health-related technical
assistance to the Syrian population in the occupied Syrian Golan;
(4) to continue providing necessary technical assistance in order to meet the health needs of
the Palestinian people, including the handicapped and injured;
(5) to also provide support to the Palestinian health and veterinary services in preparing for
unusual emergencies;
(6) to support the development of the health system in the occupied Palestinian territory,
including development of human resources;
(7) to make available the detailed report prepared by the specialized health mission to the
Gaza Strip;
(8)
to report on implementation of this resolution to the Sixty-fifth World Health Assembly.
(Ninth plenary meeting, 20 May 2011 –
Committee B, first report)
WHA64.5
Pandemic influenza preparedness: sharing of influenza viruses and
access to vaccines and other benefits1
The Sixty-fourth World Health Assembly,
Having considered the report of the Open-Ended Working Group of Member States on
Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other
benefits;2
Acknowledging the work of the Co-Chairs and the Bureau of the Open-Ended Working Group;
Welcoming the outcome of the Open-Ended Working Group of Member States on Pandemic
Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits in
elaborating the Pandemic Influenza Preparedness Framework for sharing of influenza viruses and
access to vaccines and other benefits (the “Pandemic Influenza Preparedness Framework”);
Recognizing the role of industry as an important contributor to technology innovation and
transfer in addressing the challenges of pandemic influenza preparedness and response,
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
See documents A64/8 and A64/8 Corr.1.
RESOLUTIONS AND DECISIONS
9
1.
ADOPTS, in accordance with Article 23 of the WHO Constitution, the Pandemic Influenza
Preparedness Framework, including its annexes;1
2.
URGES Member States:2
(1)
to implement the Pandemic Influenza Preparedness Framework;
(2) to support actively the wide implementation of the Pandemic Influenza Preparedness
Framework, and to consider providing adequate resources for its implementation;
3.
CALLS UPON relevant stakeholders to give priority to implementing the Pandemic Influenza
Preparedness Framework;
4.
REQUESTS the Director-General, in consultation with the Advisory Group:
(1)
to implement the Pandemic Influenza Preparedness Framework;
(2) to monitor and review the operation of the Pandemic Influenza Preparedness Framework
and all of its components, in accordance with its provisions;
(3) to report, on a biennial basis, to the World Health Assembly, through the Executive
Board, on progress in the implementation of this resolution.
(Tenth plenary meeting, 24 May 2011 –
Committee A, third report)
WHA64.6
Health workforce strengthening3
The Sixty-fourth World Health Assembly,
Having considered the reports on health system strengthening;4
Recalling resolution WHA57.19 on challenges posed by the international migration of health
personnel, which, inter alia, urged Member States to develop strategies to mitigate the adverse effects
of migration of health personnel and minimize its negative impact on health systems, and to frame and
implement policies that could enhance effective retention of health personnel;
Recalling also resolution WHA59.23 on rapid scaling up of health workforce production, which,
inter alia, recognized that shortages of health workers are interfering with efforts to achieve the
internationally agreed health-related development goals, including those contained in the Millennium
Declaration, and those of WHO’s priority programmes;
Taking note of the WHO Global Code of Practice on the International Recruitment of Health
Personnel,5 which, inter alia, recognized that an adequate and accessible health workforce is
1
See Annex 2 for the Pandemic Influenza Preparedness Framework.
2
And where applicable, regional economic integration organizations.
3
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
4
Documents A64/12 and A64/13.
5
Adopted in resolution WHA63.16.
10
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
fundamental to an integrated and effective health system and for the provision of health services, and
that Member States should take measures to meet their own needs with respect to health personnel,
namely, to educate, retain and sustain a health workforce that is appropriate for the specific conditions
of each country;
Acknowledging the ongoing development of the WHO policy guidelines on the transformative
scale-up of health professional education, which is related to the equitable and efficient increase in
quantity, quality and relevance of the skill-mix of the health workforce;
Recognizing that quantity, quality and relevance are prerequisites for the sustainable
transformative scaling up of teachers in health professional training institutions;
Recognizing that recruiters and employers are key stakeholders who may contribute to success
in the implementation of the WHO Global Code of Practice on the International Recruitment of Health
Personnel;
Noting with approval recent international calls to action regarding the importance of ensuring
scale-up and an equitable distribution of the health workforce globally, regionally and within
countries;1
Recognizing the centrality of human resources for health to the effective operation of health
systems, as highlighted in The world health report 2006,2 and that the health workforce shortages and
inefficiencies are also seriously hampering effective implementation of primary health care, as stated
in The world health report 2008,3 and expansion of health service coverage, as described in The world
health report 2010;4
Deeply concerned that shortages and inadequate distribution of appropriately trained and
motivated health workers, and inefficiencies in the ways in which the health workforce is managed
and used, remain major impediments to the effective functioning of health systems and constitute one
of the main bottlenecks to achieving the health-related Millennium Development Goals;
Realizing that increased production and improved retention of health workers, in particular in
rural areas, rely on various factors including a sufficient and sustainable health financing system,
which is to some extent determined by decisions made outside the confines of the health sector,
including in international organizations;
Observing that insufficient evidence of the effectiveness of health workforce policies and a lack
of comprehensive, reliable and up-to-date data, including analytical tools, constitute significant
challenges for Member States trying to achieve or maintain a sufficient, sustainable and effective
health workforce;
1
Including, but not limited to, the Kampala Declaration and Agenda for Global Action of March 2008, the
G8 Communiqué of July 2008; Closing the gap in a generation: health equity through action on the social determinants of
health: Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization, 2008; the
High-level Taskforce on Innovative International Financing for Health Systems, 2009; and the Venice concluding statement
on maximizing positive synergies between health systems and global health initiatives, 2009.
2
The world health report 2006. Working together for health. Geneva, World Health Organization, 2006.
3
The world health report 2008. Primary health care: now more than ever. Geneva, World Health Organization, 2008.
4
The world health report 2010. Health systems financing: the path to universal coverage. Geneva, World Health
Organization, 2010.
RESOLUTIONS AND DECISIONS
11
Concerned that many Member States, particularly those with critical shortages or imbalances of
health workers, also lack the governance, technical and managerial capacity to design and implement
efficient and effective policy interventions related to scaling up and retaining the health workforce;
Realizing that a sufficient, efficient and sustainable health workforce is at the heart of robust
health systems and a prerequisite for sustainable health improvement;
Recognizing the division of health responsibilities between national and subnational levels of
government that is unique to federated States,
1.
URGES Member States:1
(1) to implement the voluntary WHO Global Code of Practice on the International
Recruitment of Health Personnel in order that both source and destination countries may derive
benefits from the international migration of health personnel and in order to mitigate the
negative effects of health worker migration on health systems, particularly in countries with
critical health worker shortages;
(2) to prioritize, in the context of global economic conditions, public sector spending on
health, as appropriate, to ensure that sufficient financial resources are available for the
implementation of policies and strategies to scale up and retain the health workforce,
particularly in developing countries, and to recognize it as an investment in the health of the
population that contributes to social and economic development;
(3) to consider developing or maintaining a national health workforce plan as an integral part
of a validated national health plan, in accordance with national and subnational responsibilities
with increased efforts towards effective implementation and monitoring, as appropriate in the
national context;
(4) to use and implement evidence-based findings and strategies, including those from the
Global Health Workforce Alliance Taskforce on Scaling Up Education and Training, for the
successful scaling up of health worker education and training;
(5) to participate actively in the ongoing work on the WHO policy guidelines on
transformative scale-up of health professional education in order to increase the workforce
numbers and relevant skill-mix in response to country health needs and health systems context;
(6) to expand, strengthen and orient health professional training institutions, in terms of
quantity, quality and skill-mix, to be relevant to the implementation of the transformative
scaling up of health professionals;
(7) to develop strategies and policies to increase the availability of motivated and skilled
health workers in remote and rural areas, with reference to WHO global policy
recommendations on increasing access to health workers in remote and rural areas through
improved retention of the health workforce;
(8) to implement the relevant recommendations for increased retention of health workers in
rural areas, including: improved living conditions; safe and supportive working environments;
1
And, where applicable, regional economic integration organizations.
12
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
outreach support; career development and advancement programmes; supporting professional
networks; and social recognition of dedicated health personnel;
(9) to develop or strengthen in-country capacity for health workforce information systems in
order to guide, accelerate and improve country action including the collection, processing and
dissemination of information on their health workforce, covering, but not limited to, stock,
education and training capacity, distribution, migration and expenditures;
(10) to work with other sectors to generate evidence and introduce effective policy
interventions in order to address other factors that affect the availability of health workers in
rural or remote areas, such as socioeconomic deprivation, geographical barriers and distance,
transport and the acceptability of services;
2.
URGES nongovernmental organizations, international organizations, international donor
agencies, financial and development institutions and other relevant organizations working in
developing countries:
(1) to align and harmonize, in line with the Paris Declaration on Aid Effectiveness and the
Accra Agenda for Action, their education, training, recruitment and employment practices with
those of the countries in which they are based, in particular national health plans, where
available, in order to create coherence and coordination and support Member States’ efforts in
building a sustainable health workforce, strengthening health systems and improving health
outcomes;
(2) to support national long-term strategies and interventions to build and sustain a sufficient
and efficient health workforce, including investment in the future health workforce;
3.
REQUESTS the Director-General:
(1) to continue the implementation of the WHO Global Code of Practice on the International
Recruitment of Health Personnel, including, upon request, provision of technical support to
Member States in implementing the Global Code;
(2) to provide leadership at global and regional levels by generating evidence and
recommending effective interventions to address factors that hinder access to health workers; to
work closely with partner agencies in the multilateral system on appropriate measures to support
Member States’ efforts to maintain or achieve a sufficient, sustainable and effective workforce;
and to advocate for this topic to be placed high on global development and research agendas;
(3) to provide technical support to Member States, upon request, for their efforts to scale up
education and training and improve the retention of the health workforce; including the
identification of efficient and effective health workforce policies and the development and
implementation of national health workforce plans;
(4) to support Member States, upon request, in strengthening their capacity for coordination
on health workforce issues between ministries of health, other ministries and other relevant
stakeholders;
(5) to encourage and support Member States in developing and maintaining a framework for
health workforce information systems, in order to accommodate the collection, processing and
dissemination of information on their health workforce, including stock, migration, education
and training capacity, skill-mix, distribution, expenditures, positions and determinants of
change;
RESOLUTIONS AND DECISIONS
13
(6) to encourage Member States to support the ongoing development of the WHO policy
guidelines on transformative scale-up of health professional education in order to increase the
quantity, quality and relevance of the health workforce, and towards addressing shortages in
human resources for health in an equitable and efficient manner;
(7) to promote research relevant for both developing and developed countries on efficient and
effective policies and interventions to improve scale-up and retention of the health workforce,
with the aim of establishing and maintaining an accessible global evidence base for best
practice, and efficient and effective health workforce policies and interventions, including
supporting the strengthening of knowledge centres with the purpose of accommodating
translation of evidence and best practice into context-specific policy solutions;
(8) to strengthen capacity within the Secretariat with the purpose of giving sufficient priority
to relevant tasks related to the Organization’s wider efforts in addressing the global health
workforce crisis;
(9) to report on progress in implementing this resolution to the World Health Assembly,
through the Executive Board, in a manner integrated with the reporting on resolution
WHA63.16 on the WHO Global Code of Practice on the International Recruitment of Health
Personnel.
(Tenth plenary meeting, 24 May 2011 –
Committee A, fourth report)
WHA64.7
Strengthening nursing and midwifery1
The Sixty-fourth World Health Assembly,
Having considered the reports on health system strengthening;2
Recognizing the need to build sustainable national health systems and to strengthen national
capacities to achieve the goal of reduced health inequities;
Recognizing the crucial contribution of the nursing and midwifery professions to strengthening
health systems, to increasing access to comprehensive health services for the people they serve, and to
the efforts to achieve the internationally agreed health-related development goals, including the
Millennium Development Goals and those of the World Health Organization’s programmes;
Concerned at the continuing shortage and maldistribution of nurses and midwives in many
countries and the impact of this on health care and more widely;
Acknowledging resolution WHA62.12 on primary health care, including health system
strengthening, which called, inter alia, for the renewal and strengthening of primary health care, as
well as urging Member States to train and retain adequate numbers of health workers, with appropriate
skill-mix, including primary care nurses and midwives, in order to redress current shortages of health
workers to respond effectively to people’s health needs;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Documents A64/12 and A64/13.
14
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Acknowledging the ongoing WHO initiatives on the scaling up of transformative health
professional education and training in order to increase the workforce numbers and the relevant skillmix in response to the country health needs and health systems context;
Recognizing the global policy recommendations by WHO on increasing access to health
workers in remote and rural areas through improved retention1 as an evidence platform for developing
effective country policies for rural retention of nursing and midwifery personnel;
Taking note of the WHO Global Code of Practice on the International Recruitment of Health
Personnel;2
Reaffirming the call for governments and civil society to strengthen capacity to address the
urgent need for skilled health workers, particularly midwives, made in the WHO UNFPA UNICEF
World Bank Joint Statement on Maternal and Newborn Health;
Noting the importance of multidisciplinary involvement, including that of nurses and midwives,
in high-quality research that grounds health and health systems policy in the best scientific knowledge
and evidence, as elaborated in WHO’s strategy on research for health, endorsed in resolution
WHA63.21;
Noting that nurses and midwives form the majority of the workforce in many countries’ health
systems, and recognizing that the provision of knowledge-based and skilled health services maximizes
the physical, psychological, emotional and social well-being of individuals, families and societies;
Recognizing the fragmentation of health systems, the shortage of human resources for health
and the need to improve collaboration in education and practice, and primary health care services;
Having considered the reports on progress in the implementation of resolution WHA59.27 on
strengthening nursing and midwifery;3
Mindful of previous resolutions to strengthen nursing and midwifery (WHA42.27, WHA45.5,
WHA47.9, WHA48.8, WHA49.1, WHA54.12 and WHA59.27) and the new strategic directions for
nursing and midwifery services in place for the period 2011–2015;4
Recognizing the need to improve the education of nurses and midwives,
1.
URGES Member States to translate into action their commitment to strengthening nursing and
midwifery by:
(1) developing targets and action plans for the development of nursing and midwifery, as an
integral part of national or subnational health plans, that are reviewed regularly in order to
respond to population-health needs and health system priorities as appropriate;
1
Increasing access to health workers in remote and rural areas through improved retention: global policy
recommendations. Geneva, World Health Organization, 2010.
2
Adopted in resolution WHA63.16.
3
See documents A61/17 and A63/27.
4
Document WHO/HRH/HPN/10.1.
RESOLUTIONS AND DECISIONS
15
(2) forging strong, interdisciplinary health teams to address health and health system
priorities, recognizing the distinct contribution made by the knowledge and expertise of nurses
and midwives;
(3) participating in the ongoing work of WHO’s initiatives on scaling up transformative
education and training in nursing and midwifery in order to increase the workforce numbers and
the mix of skills that respond to the country’s health needs and are appropriate to the health
system context;
(4) collaborating within their regions and with the nursing and midwifery professions in the
strengthening of national or subnational legislation and regulatory processes that govern those
professions, including the development of competencies for the educational and technical
preparation of nurses and midwives, and systems for sustaining those competencies; and giving
consideration to the development of the education continuum that is necessary for attaining the
required level of expertise of nursing and midwifery researchers, educators and administrators;
(5) strengthening the dataset on nurses and midwives as an integral part of national and
subnational health workforce information systems, and maximizing use of this information for
evidence-based policy decisions;
(6) harnessing the knowledge and expertise of nursing and midwifery researchers in order to
contribute evidence for health system innovation and effectiveness;
(7) engaging actively the expertise of nurses and midwives in the planning, development,
implementation and evaluation of health and health system policy and programming;
(8) implementing strategies for enhancement of interprofessional education and collaborative
practice including community health nursing services as part of people-centred care;
(9) including nurses and midwives in the development and planning of human resource
programmes that support incentives for recruitment and retention, and strategies for improving
workforce issues, such as remuneration, conditions of employment, career development and
advancement, and development of positive work environments;
(10) promoting the establishment of national and subnational mechanisms in order to develop
and support the effective interventions proposed in the global policy recommendations on
increasing access to health workers in remote and rural areas through improved retention;1
(11) implementing the WHO Global Code of Practice on the International Recruitment of
Health Personnel, given the national impact of the loss of trained nursing staff, at national and
local level as appropriate;
2.
REQUESTS the Director-General:
(1) to strengthen WHO’s capacity for development and implementation of effective nursing
and midwifery policies and programmes through continued investment and appointment of
professional nurses and midwives to specialist posts in the Secretariat both at headquarters and
in regions;
1
Increasing access to health workers in remote and rural areas through improved retention: global policy
recommendations. Geneva, World Health Organization, 2010.
16
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
(2) to engage actively the knowledge and expertise of the Global Advisory Group on Nursing
and Midwifery in key policies and programmes that pertain to health systems, the social
determinants of health, human resources for health and the Millennium Development Goals;
(3) to provide technical support and evidence for the development and implementation
of policies, strategies and programmes on interprofessional education and collaborative practice,
and on community health nursing services;
(4) to provide support to Member States in optimizing the contributions of nursing and
midwifery to implementing national health policies and achieving the internationally agreed
health-related development goals, including those contained in the United Nations Millennium
Declaration;
(5) to encourage the involvement of nurses and midwives in the integrated planning of
human resources for health, particularly with respect to strategies for maintaining adequate
numbers of competent nurses and midwives;
(6) to report on progress in implementing this resolution to the World Health Assembly,
through the Executive Board, in a manner integrated with the reporting on resolution
WHA63.16 on the WHO Global Code of Practice on the International Recruitment of Health
Personnel.
(Tenth plenary meeting, 24 May 2011 –
Committee A, fourth report)
WHA64.8
Strengthening national policy dialogue to build more robust health
policies, strategies and plans1
The Sixty-fourth World Health Assembly,
Having considered the report on health system strengthening: improving support to policy
dialogue around national health policies, strategies and plans;2
Having also considered the importance of policy directions suggested by the world health
reports for 2008 and 2010;3 resolution WHA62.12 on primary health care, including health system
strengthening; resolution EUR/RC60/R5 on addressing key public health and health policy challenges
in Europe: moving forwards in the quest for better health in the WHO European Region; resolution
WPR/RC61.R2 on the Western Pacific Regional Strategy for health systems based on the values of
primary health care; resolution AFR/RC60/R1 on a strategy for addressing key determinants of health
in the African Region; document AFR/RC60/7 on health systems strengthening: improving district
health service delivery, and community ownership and participation; and document SEA/RC63/9 on
the development of national health plans and strategies;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Document A64/12.
3
The world health report 2008. Primary health care: now more than ever. Geneva, World Health Organization,
2008. The world health report 2010. Health systems financing: the path to universal coverage. Geneva, World Health
Organization, 2010.
RESOLUTIONS AND DECISIONS
17
Recognizing that robust and realistic national health policies, strategies and plans are essential
for strengthening health systems based on primary health care;
Underlining the importance of coherent and balanced policies, strategies and plans under
ministries of health with respect to efforts to achieve the Millennium Development Goals;
Acknowledging that many Member States have made efforts to ensure that their national health
policies, strategies and plans respond better to growing expectations for improved health and better
services;
Noting that an inclusive policy dialogue with a comprehensive range of stakeholders, within and
beyond government, including civil society organizations, the private sector, and health professionals
and academics, within the health and other sectors, is critical to increasing the likelihood that national
policies, strategies and plans will be appropriately designed and implemented and will yield the
expected results,
1.
URGES Member States:1
(1) to show effective leadership and ownership of the process of establishing robust national
or subnational health policies and strategies, basing that process on broad and continuous
consultation and engagement of all relevant stakeholders;
(2) to base their national or subnational health policies, strategies and plans on the
overarching goals of universal coverage, people-centred primary care and health in all policies,
as well as on a comprehensive, balanced and evidence-based assessment of the country’s health
and its health system challenges;
(3) to ensure that national or subnational health policies, strategies and plans are ambitious
but realistic with respect to available resources and the capacities of staff and institutions, and
that they address the entire health sector, public as well as private, and the social determinants
of health;
(4) to ensure that national health policies, strategies and plans are integrated with subnational
operational plans, disease or life-cycle programmes, and are linked to the country’s overall
development and political agenda;
(5) to regularly monitor, review and adjust their national or subnational health policies,
strategies and plans with a view to developing evidence-based responses to evolving challenges
and opportunities, and to involve all relevant stakeholders;
(6) to strengthen their institutional capacity, as appropriate, in harmonizing and aligning
donor programmes with national policies, strategies, priorities and plans;
(7) to promote the engagement and empowerment of all stakeholders, including civil society
and communities, the private sector, health professionals and academics, in order that they
participate actively and efficiently in policy dialogue concerning the performance of national
policies, strategies and plans;
1
And, where applicable, regional economic integration organizations.
18
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
2.
CALLS upon development agencies and other partners to strengthen adherence to the principles
of the Paris Declaration on Aid Effectiveness, of ownership, alignment, harmonization, results, and
mutual accountability, encouraging efforts through mechanisms such as the International Health
Partnership;
3.
REQUESTS the Director-General:
(1) to renew the Organization’s role at country level as a facilitator of inclusive policy
dialogue around national health policies, strategies and plans, to reflect this across the
Organization’s workplans and operations, and to provide technical input to the conduct of the
planning process, as appropriate;
(2) to promote the principles of the Paris Declaration on Aid Effectiveness, of ownership,
alignment, harmonization, results, and mutual accountability, based on priorities set out in the
national health policies, strategies and plans;
(3) to support Member States in their efforts to ensure the ownership, quality and
coordination of the technical support they receive, and to foster cross-country and regional
learning and cooperation;
(4) to strengthen the Organization’s capacity at all levels for enhanced and integrated support
to national policy dialogue around national health policies, strategies and plans;
(5) to report to the Sixty-fifth World Health Assembly, through the Executive Board, on
progress made, obstacles faced and results obtained in enhancing support provided to Member
States for national policy dialogue around national health policies, strategies and plans.
(Tenth plenary meeting, 24 May 2011 –
Committee A, fourth report)
WHA64.9
Sustainable health financing structures and universal coverage1
The Sixty-fourth World Health Assembly,
Having considered the reports on health system strengthening;2
Having also considered The world health report 2010,3 which received strong support from the
International Ministerial Conference on Health Systems Financing – Key to Universal Coverage
(Berlin, November 2010);
Recalling resolution WHA58.33 on sustainable health financing, universal coverage and social
health insurance;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Documents A64/12 and A64/13.
3
The world health report 2010. Health systems financing: the path to universal coverage. Geneva, World Health
Organization, 2010.
RESOLUTIONS AND DECISIONS
19
Recalling also Article 25.1 of the Universal Declaration of Human Rights, which states that
everyone has the right to a standard of living adequate for the health and well-being of himself and of
his family, including food, clothing, housing and medical care and necessary social services, and the
right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack
of livelihood in circumstances beyond his control;
Recognizing that effective health systems delivering comprehensive health services, including
preventive services, are of utmost importance for health, economic development and well-being and
that these systems need to be based on equitable and sustainable financing as mentioned in the Tallinn
Charter: Health Systems for Health and Wealth (2008);
Underlining the valuable contribution made by fair and sustainable financing structures towards
achieving health-related Millennium Development Goal 4 (Reduce child mortality), Goal 5 (Improve
maternal health), and Goal 6 (Combat HIV/AIDS, malaria and other diseases), as well as Goal 1
(Eradicate extreme poverty and hunger);
Having considered The world health report 20081 and resolution WHA62.12, that highlighted
universal coverage as one of the four key pillars of primary health care and services through patientcentred care, inclusive leadership and health in all policies;
Noting that health-financing structures in many countries need to be further developed and
supported in order to expand access to necessary health care and services for all, while preventing and
providing protection against disastrous financial risks;
Accepting that, irrespective of the source of financing for the health system selected, equitable
prepayment and pooling at population level, and the avoidance, at the point of delivery, of direct
payments that result in financial catastrophe and impoverishment, are basic principles for achieving
universal health coverage;
Considering that the choice of a health-financing system should be made within the particular
context of each country, and that it is important to regulate and maintain the core functions of risk
pooling, purchasing, and delivery of basic services;
Acknowledging that a number of Member States are pursuing health-financing reforms that may
involve a mix of public and private approaches, and a financing mix of contribution-based and taxfunded inputs;
Recognizing the important role of State legislative and executive bodies, with the support of
civil society, in further reform of health-financing systems with a view to achieving universal
coverage,
1.
URGES Member States:2
(1) to ensure that health-financing systems evolve so as to avoid significant direct payments
at the point of delivery and include a method for prepayment of financial contributions for
health care and services as well as a mechanism to pool risks among the population in order to
avoid catastrophic health-care expenditure and impoverishment of individuals as a result of
seeking the care needed;
1
The world health report 2008. Primary health care: now more than ever. Geneva, World Health Organization, 2008.
2
And, where applicable, regional economic integration organizations.
20
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
(2) to aim for affordable universal coverage and access for all citizens on the basis of equity
and solidarity, so as to provide an adequate scope of health care and services and level of costs
covered, as well as comprehensive and affordable preventive services through strengthening of
equitable and sustainable financial resource budgeting;
(3) to continue, as appropriate, to invest in and strengthen the health-delivery systems, in
particular primary health care and services, and adequate human resources for health and health
information systems, in order to ensure that all citizens have equitable access to health care and
services;
(4) to ensure that external funds for specific health interventions do not distort the attention
given to health priorities in the country, that those funds increasingly implement the principles
of aid effectiveness, and that they contribute in a predictable way to the sustainability of
financing;
(5) to plan the transition of their health systems to universal coverage, while continuing to
safeguard the quality of services and to meet the needs of the population in order to reduce
poverty and to attain internationally agreed development goals, including the Millennium
Development Goals;
(6) to recognize that, when managing the transition of the health system to universal
coverage, each option will need to be developed within the particular epidemiological,
macroeconomic, sociocultural and political context of each country;
(7) to take advantage, where appropriate, of opportunities that exist for collaboration between
public and private providers and health-financing organizations, under strong overall
government-inclusive stewardship;
(8) to promote the efficiency, transparency and accountability of health-financing governance
systems;
(9) to ensure that overall resource allocation strikes an appropriate balance between health
promotion, disease prevention, rehabilitation and health-care provision;
(10) to share experiences and important lessons learnt at the international level for
encouraging country efforts, supporting decision-makers, and boosting reform processes;
(11) to establish and strengthen institutional capacity in order to generate country-level
evidence and effective, evidence-based policy decision-making on the design of universal health
coverage systems, including tracking the flows of health expenditures through the application of
standard accounting frameworks;
2.
REQUESTS the Director-General:
(1) to convey to the United Nations Secretary-General the importance of universal health
coverage for discussion by the United Nations General Assembly at a forthcoming session;
(2) to provide a report on measures taken and progress made in the implementation of
resolution WHA58.33, especially in regard to equitable and sustainable health financing and
social protection of health in Member States;
RESOLUTIONS AND DECISIONS
21
(3) to work closely with other United Nations organizations, international development
partners, foundations, academia and civil society organizations, in fostering efforts towards
achieving universal coverage;
(4) to prepare a plan of action for the Secretariat to support Member States in realizing
universal coverage, as envisaged in resolution WHA62.12 and The world health report 2010;1
(5) to prepare an estimate of the number of people covered by a basic health insurance that
provides access to basic health care and services, that estimate being broken down by country
and region;
(6) to provide, in response to requests from Member States, technical support for
strengthening capacities and expertise in the development of health-financing systems,
particularly equitable prepayment schemes, with a view to achieving universal coverage by
providing comprehensive health care and services for all, including strengthening capacity in
tracking resource flows through the application of standard accounting frameworks;
(7) to facilitate within existing forums the continuous sharing of experiences and lessons
learnt on social health protection and universal coverage;
(8) to report to the Sixty-fifth World Health Assembly and thereafter every three years,
through the Executive Board, on the implementation of this resolution, including on outstanding
issues raised by Member States during the Sixty-fourth World Health Assembly.
(Tenth plenary meeting, 24 May 2011 –
Committee A, fourth report)
WHA64.10
Strengthening national health emergency and disaster management
capacities and the resilience of health systems2
The Sixty-fourth World Health Assembly,
Having considered the reports on health system strengthening;3
Recalling resolutions WHA58.1 on health action in relation to crises and disasters, and
WHA59.22 on emergency preparedness and response, resolution WHA61.19 on climate change and
health, and other World Health Assembly and Regional Committee resolutions and action plans, inter
alia, on health security and the International Health Regulations (2005), as well as on pandemic
preparedness, safe hospitals and other matters related to emergencies and disasters at local, subnational
and national levels;
Recalling also United Nations General Assembly resolution 60/195, which endorsed the Hyogo
Declaration and the Hyogo Framework for Action 2005–2015: Building the Resilience of Nations and
Communities to Disasters, as well as resolutions 61/198, 62/192, 63/216, 64/200 and 64/251, which,
1
The world health report 2010. Health systems financing: the path to universal coverage, Geneva, World Health
Organization, 2010.
2
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
3
Documents A64/12 and A64/13.
22
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
inter alia, called upon Member States to increase efforts to implement the Hyogo Framework, to
strengthen risk-reduction and emergency preparedness measures at all levels, and to encourage the
international community and relevant United Nations entities to support national efforts aimed at
strengthening capacity to prepare for and respond to disasters;
Reaffirming that countries should ensure the protection of the health, safety and welfare of their
people and should ensure the resilience and self-reliance of the health system, which is critical for
minimizing health hazards and vulnerabilities and delivering effective response and recovery in
emergencies and disasters;
Regretting the tragic and enormous loss of life, as well as the injuries, disease and disabilities
resulting from emergencies, disasters and crises of all descriptions;
Mindful that emergencies and disasters also result in the damage and destruction of hospitals
and other parts of the health infrastructure, the weakened ability of health systems to deliver health
services; and setbacks for health development and the achievement of the Millennium Development
Goals;
Expressing deep concern that continuing poverty, increasing urbanization, and climate change
are expected to increase the health risks and impact of emergencies and disasters on many countries
and communities;
Acknowledging that most actions to manage the risks to health from natural, biological,
technological and societal hazards, including immediate emergency response, are provided by localand country-level actors across all health disciplines, including mass casualty management, mental
health and noncommunicable diseases, communicable diseases, environmental health, maternal and
newborn health, reproductive health, and nutrition and other cross-cutting health issues;
Recognizing the contribution of other sectors and disciplines to the health and well-being of
people at risk from emergencies and disasters, including local government, planners, architects,
engineers, emergency services and civil protection, and academia;
Concerned that country and community capacities to manage major emergencies and disasters
are often overwhelmed, and that coordination, communications and logistics are often revealed as the
weakest aspects of health emergency management;
Appreciating that some countries, including those with low-income or emerging country
development status, have reduced mortality and morbidity in disaster situations through their
investment in emergency and disaster risk-reduction measures, with the support of local, regional and
global partners;
Recognizing also that WHO plays an important role as a member of the United Nations
International Strategy for Disaster Reduction system and as the health cluster lead in the framework of
humanitarian reform, and works closely with other members of the international community, such as
the United Nations Secretariat of the International Strategy for Disaster Reduction, UNDP, UNICEF,
the United Nations Office for the Coordination of Humanitarian Affairs, the International Red Cross
and Red Crescent Movement, and other nongovernmental organizations, on supporting country
capacity development and developing institutional capacities for multisectoral emergency and disaster
risk-management, which includes disaster risk-reduction;
Building on the International Strategy for Disaster Reduction, the 2008–2009 World Disaster
Reduction Campaign on Hospitals Safe from Disasters, the 2010–2011 Campaign on Disaster
Resilient Cities, World Health Day 2008 on Climate Change and Health, World Health Day 2009 on
RESOLUTIONS AND DECISIONS
23
Hospitals Safe in Emergencies, and World Health Day 2010 on Urban Health Matters, which have
resulted in local, subnational, national and global actions on reducing risks to health from emergencies
and disasters;
Recognizing further that improved health outcomes from emergencies and disasters require
urgent additional action at country, regional and global levels to ensure that the local, subnational and
national health risk-reduction and overall response in emergencies and disasters are timely and
effective and that health services remain operational when they are most needed, in this respect
bearing in mind that emergencies and disasters affect men and women differently,
1.
URGES Member States:1
(1) to strengthen all-hazards health emergency and disaster risk-management programmes
(including disaster risk-reduction, emergency preparedness and response)2 as part of national
and subnational health systems, supported by, and with effective enforcement of, legislation,
regulations and other measures, to improve health outcomes, reduce mortality and morbidity,
protect health infrastructure and strengthen the resilience of the health system and society at
large, and mainstream a gender perspective into all phases of such programmes;
(2) to integrate all-hazards health emergency and disaster risk-management programmes
(including disaster risk-reduction) into national or subnational health plans and institutionalize
capacities for coordinated health and multisectoral action to assess risks, proactively reduce
risks, and prepare for, respond to, and recover from, emergencies, disasters and other crises;
(3) to facilitate access by concerned government and other related agencies to information on
types and quantities of hazardous materials stored, used or transported, in order to support
effective health emergency and disaster risk-management;
(4) to develop programmes on safe and prepared hospitals that ensure: that new hospitals and
health facilities are located and built safely so as to withstand local hazards; that the safety of
existing facilities is assessed and remedial action is taken; and that all health facilities are
prepared to respond to internal and external emergencies;
(5) to establish, promote and foster regional and subregional collaboration, as well as
interregional cooperation within WHO, including sharing of experience and expertise for
capacity development in risk-reduction, response and recovery;
(6) to strengthen the role of the local health workforce in the health emergency management
system, to provide local leadership and health services, through enhanced planning, training for
all health-care workers and access to other resources;
2.
CALLS UPON Member States, donors and development cooperation partners to allocate
sufficient resources for health emergency and disaster risk-management programmes and partners
through international cooperation for development, humanitarian appeals, and support for WHO’s role
in health emergency and disaster risk-management matters;
1
2
And, where applicable, regional economic integration organizations.
Health emergency and disaster risk-management includes all measures to assess risks, proactively reduce risks,
prepare for, respond to, and recover from, emergencies, disasters and other crises.
24
3.
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
REQUESTS the Director-General:
(1) to ensure that WHO at all levels has enhanced capacity and resources, and optimizes its
expertise across all disciplines in the Organization, in order to provide the necessary technical
guidance and support to Member States and partners for developing health emergency and
disaster risk-management programmes at national, subnational and local levels;
(2) to strengthen collaboration with and ensure coherence and complementarity of actions
with those of relevant entities, including those in the public, private, nongovernmental and
academic sectors, in order to support country and community health emergency and disaster
risk-management, which includes disaster risk-reduction, as well as ongoing efforts by Member
States to implement the International Health Regulations (2005);
(3) to strengthen the evidence base for health emergency and disaster risk-management,
including operational research and economic assessments;
(4) to support national and subnational assessments of risks and capacities for health
emergency and disaster risk-management, as a basis for catalysing action and strengthening
national and subnational health emergency and disaster risk-management capacities, including
disaster risk-reduction;
(5) to report to the Sixty-sixth World Health Assembly through the Executive Board at its
132nd session, on progress made in implementing this resolution;
(6) to consider, as appropriate, providing support to regional and subregional networks, as
well as interregional cooperation with WHO, in order to strengthen their collaboration on health
emergency and disaster risk management.
(Tenth plenary meeting, 24 May 2011 –
Committee A, fourth report
WHA64.11
Preparations for the High-level Meeting of the United Nations General
Assembly on the Prevention and Control of Non-communicable
Diseases, following the Moscow Conference1, 2
The Sixty-fourth World Health Assembly,
Having considered the report on WHO’s role in the preparation, implementation and follow-up
to the High-level Meeting of the United Nations General Assembly on the Prevention and Control of
Non-communicable Diseases;3
Deeply concerned that the global burden and threat of noncommunicable diseases continue to
grow, in particular in developing countries, and convinced that global action is necessary and urgent
1
First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control (Moscow,
Russian Federation, 28–29 April 2011).
2
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
3
Document A64/21.
RESOLUTIONS AND DECISIONS
25
response is needed, including by effectively addressing the key risk factors for noncommunicable
diseases;
Reaffirming its commitment to the aim of the global strategy for the prevention and control of
noncommunicable diseases to reduce premature mortality and improve quality of life;1
Further recalling United Nations General Assembly resolution 64/265 in which the General
Assembly decided to convene a high-level meeting of the General Assembly in September 2011, with
the participation of Heads of State and Government, on the prevention and control of
noncommunicable diseases, as well as resolution 65/238 on the scope, modalities, format and
organization of the high-level meeting;
Recognizing the leading role of the World Health Organization as the primary specialized
agency for health, and reaffirming the leadership role of WHO in promoting global action against
noncommunicable diseases;
Noting with appreciation the first WHO Global status report on noncommunicable diseases
launched on 27 April 2011, which may serve as an input into the preparatory process for the high-level
meeting;
Noting also the outcomes of the regional consultations which were held by WHO in
collaboration with Member States, with the support of relevant United Nations agencies and entities,
which will serve to provide inputs to the preparations for the high-level meeting, as well as to the
meeting itself;
Welcoming the outcome of the First Global Ministerial Conference on Healthy Lifestyles and
Noncommunicable Disease Control, which was organized by the Russian Federation and WHO from
28 to 29 April 2011 in Moscow,
1.
ENDORSES the Moscow Declaration,2 including as a key input for the preparations leading to
the high-level meeting;
2.
URGES Member States:3
(1) to continue to support the preparations at national, regional and international levels for
the high-level meeting, including, where feasible and relevant, a situation analysis of
noncommunicable diseases and their risk factors, as well as an assessment of national capacity
and health system response to address noncommunicable diseases;
(2) to be represented at the level of Heads of State and Government at the high-level meeting
and to call for action through a concise action-oriented outcome document;
(3) to consider, as appropriate and where relevant, including in their national delegations to
the high-level meeting, parliamentarians, and representatives of civil society, including
nongovernmental organizations, academia and networks working on the control and prevention
of noncommunicable diseases;
1
See resolution WHA53.17.
2
See Annex 3.
3
And, where applicable, regional economic integration organizations.
26
3.
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
REQUESTS the Director-General:
(1) to continue exercising the leading role of WHO as the primary specialized agency for
health, working together in a coordinated way with the United Nations, its specialized agencies,
funds and programmes, and other relevant intergovernmental organizations and international
financial institutions, in supporting Member States, including:
(i)
in undertaking concerted action and a coordinated response in order to address
promptly and appropriately the challenges posed by noncommunicable diseases,
including further building on available situation analyses on noncommunicable diseases
and risk factors; and
(ii) in highlighting the social and economic impact of noncommunicable diseases,
including financial challenges, in particular in developing countries;
(2) to take into account the outcomes from the Moscow Conference in the preparations for
the high-level meeting;
(3) to ensure that the Secretariat has adequate financial and human resources to prepare for
the high-level meeting and to respond swiftly to its recommendations;
(4) to report to the Sixty-fifth World Health Assembly, through the Executive Board, on the
outcomes of the first Global Ministerial Conference on Healthy Lifestyles and
Noncommunicable Disease Control and the high-level meeting, and to develop, together with
relevant United Nations agencies and entities, an implementation and follow-up plan for the
outcomes, including its financial implications, for submission to the Sixty-sixth World Health
Assembly, through the Executive Board.
(Tenth plenary meeting, 24 May 2011 –
Committee A, fifth report)
WHA64.12
WHO’s role in the follow-up to the United Nations High-level Plenary
Meeting of the General Assembly on the Millennium Development
Goals (New York, September 2010)1
The Sixty-fourth World Health Assembly,
Having considered the reports on the health-related Millennium Development Goals;2
Recalling resolutions WHA63.15 and WHA61.18 on monitoring of the achievement of the
health-related Millennium Development Goals, and WHA63.24 on accelerated progress towards
achievement of Millennium Development Goal 4 to reduce child mortality: prevention and treatment
of pneumonia;
Expressing deep concern at the slow pace of progress in achieving Millennium Development
Goals 4 and 5 on reducing child mortality and on improving maternal health;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Documents A64/11 and A64/11 Add.1.
RESOLUTIONS AND DECISIONS
27
Acknowledging that much more needs to be done in achieving the Millennium Development
Goals as progress has been uneven among regions and between and within countries, despite the fact
that developing countries have made significant efforts;
Recognizing that adequate antenatal care reduces the risks of maternal mortality, prematurity
and other complications of pregnancy and delivery that can result in poor health outcomes for mothers
and neonates;
Recognizing also the need to work towards greater transparency and accountability in
international development cooperation regarding health, in both donor and developing countries,
focusing on adequate and predictable financial resources as well as their improved quality and
targeting;
Welcoming the United Nations Secretary-General’s Global Strategy for Women’s and
Children’s Health launched at the United Nations High-level Plenary Meeting of the General
Assembly on the Millennium Development Goals (New York, September 2010), and acknowledging
the strong political and financial commitment by Member States to follow up and implement the
strategy;
Noting the United Nations Secretary-General’s request that WHO lead a process to determine
the most effective international institutional arrangements for global reporting, oversight and
accountability on women’s and children’s health, including through the United Nations system;
Stressing that the monitoring of resource flows and results is a vital requirement for improving
the accountability and responsiveness by governments and international development partners in
addressing health issues;
Welcoming also the establishment of the Commission on Information and Accountability for
Women’s and Children’s Health, which consists of high-level representatives;
Stressing also that concerns related to health equity and rights should also be addressed in
efforts to achieve the Millennium Development Goals;
Stressing further that the Commission should take into account relevant existing data collections
and existing performance indicators;
Welcoming further the final report of the Commission and its set of recommendations for
strengthening accountability for resources and results in women and children’s health,
1.
URGES Member States1 to implement the recommendations provided by the Commission on
Information and Accountability for Women’s and Children’s Health to improve the accountability of
results and resources;
2.
REQUESTS the Executive Board to review progress on the implementation of the
recommendations of the Commission, starting at its 130th session, January 2012;
1
And, where applicable, regional economic integration organizations.
28
3.
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
REQUESTS the Director-General:
(1) to ensure the effective engagement of all stakeholders in the follow-up to the work of the
Commission;
(2) to report annually until 2015 to the World Health Assembly on progress achieved in
connection with the agenda item concerning the Millennium Development Goals.
(Tenth plenary meeting, 24 May 2011 –
Committee A, fifth report)
WHA64.13
Working towards the reduction of perinatal and neonatal mortality1
The Sixty-fourth World Health Assembly,
Having considered the reports on the health-related Millennium Development Goals;2
Recalling resolution WHA58.31 advocating universal coverage of maternal, newborn and child
health interventions;
Recalling also Millennium Development Goals 4 and 5, with their respective targets to reduce
under-five mortality by two-thirds and maternal mortality by three-quarters, between 1990 and 2015;
Recognizing the importance of the Global Strategy for Women’s and Children’s Health
launched in September 2010 by the Secretary-General of the United Nations and welcoming the report
of the Commission on Information and Accountability for Women’s and Children’s Health;
Recognizing also the Partnership for Maternal, Newborn and Child Health, which reflects the
growing international interest in and attention to this issue, and whose objective is to coordinate and
intensify national, regional and global activities along the continuum of care for maternal and child
health to achieve the Millennium Development Goals;
Taking into account the request by Member States to implement the WHO regional strategies;
Aware that WHO Member States have undertaken a number of actions and programmes to
reduce perinatal and neonatal morbidity and mortality and meet the targets set by the Millennium
Development Goals, developing their respective National Plans for the Accelerated Reduction of
Maternal and Child Mortality, to improve equitable access, timeliness, continuity and quality of health
care for women of childbearing age and newborn infants;
Noting the conclusion of the World Health Assembly that there has been insufficient and
uneven progress towards achieving Millennium Development Goal 5 and an increase in the maternal
mortality ratio in a number of countries, and that, while there has been progress towards achieving
Millennium Development Goal 4 in terms of the reduction of child mortality, progress has stagnated in
relation to the reduction of perinatal and neonatal mortality;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Documents A64/11 and A64/11 Add.1.
RESOLUTIONS AND DECISIONS
29
Concerned by the limited resources for disease prevention and treatment of newborn infants in
developing countries, which contribute to high perinatal and neonatal mortality rates;
Recognizing further the evidence that early and exclusive breastfeeding significantly reduces
perinatal and neonatal mortality and recalling, in this regard, the importance of the implementation of
the global strategy for infant and young child feeding and resolution WHA63.23 and other related
resolutions;
Recognizing in addition that perinatal and neonatal mortality is a significant social and
economic burden that seriously affects countries and in particular developing countries, that rates
should be reduced both by preventing the most common problems such as prematurity, sepsis and
respiratory conditions, and also by implementing basic, high-impact and low-cost interventions
founded on solid scientific evidence;
Recognizing also that universal access to cost-effective perinatal and neonatal health
interventions, including through the application of outreach, family, community and facility-based
prevention, promotion and treatment services, significantly reduces a huge proportion of perinatal and
neonatal deaths worldwide;
Aware that meeting the targets of Millennium Development Goals 4 and 5 will require intense
health and intersectoral efforts with a high level of political commitment,
1.
URGES Member States:
(1) to ensure that health authorities in countries with high perinatal and neonatal mortality
rates use their stewardship and leadership to involve other institutions and sectors, to strengthen
capacity to achieve a greater reduction in avoidable neonatal and perinatal mortality in the
context of improving the continuum of maternal and child health;
(2) to further promote political commitment for effective implementation of the existing
national, regional and/or global plans with the application of evidence-based strategies and
interventions, including the Baby-Friendly Hospital Initiative, to improve perinatal and neonatal
health and increase equitable access to quality maternal, newborn and child health services;
(3) to advance perinatal and neonatal care as a priority and develop, as appropriate, plans for
universal access to cost-effective interventions, including actions to address sepsis and
nosocomial infections, information and behaviour change communication, skilled birth
attendants and early postnatal care, and early and exclusive breastfeeding;
(4) to strengthen the perinatal and neonatal mortality surveillance system, including data and
vital statistics collection as well as monitoring and reporting mechanisms;
2.
REQUESTS the Director-General:
(1) to continue to raise awareness within the international community about the global
burden of perinatal and neonatal mortality and promote, based on current best practices, targeted
plans to increase access to high quality and safe health services that prevent and treat perinatal
and neonatal conditions within an integrated mother and child health package, including
reproductive health;
(2) to strengthen regional and country-level institutional capacity and human resources,
including skilled birth attendants and essential newborn care, such as the Baby-Friendly
Hospital Initiative, to identify innovative solutions, and promote research to address the main
30
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
causes of perinatal and neonatal mortality such as prematurity, sepsis, respiratory conditions and
infections, in particular of nosocomial origin;
(3) to support coordination of actions with relevant WHO entities and United Nations
agencies and other stakeholders, and strengthen or build partnerships to promote intra- and
inter-regional collaboration in order to enhance effectiveness of action in this specific area;
(4) to provide Member States with the necessary assistance and technical advice to develop
and implement national policies, plans and strategies for the prevention and reduction of
perinatal and neonatal mortality, and related maternal morbidity and mortality;
(5) to report to the Sixty-fifth World Health Assembly on progress achieved in connection
with the agenda item concerning the Millennium Development Goals.
(Tenth plenary meeting, 24 May 2011 –
Committee A, sixth report)
WHA64.14
Global health sector strategy on HIV/AIDS, 2011–20151
The Sixty-fourth World Health Assembly,
Recalling resolution WHA63.19 in which the Director-General was requested, inter alia, to
develop a WHO HIV/AIDS strategy for 2011–2015 that builds on previous WHO HIV/AIDS
strategies and plans endorsed by several Health Assemblies, including resolutions WHA53.14,
WHA56.30, WHA59.12 and WHA59.19;
Having considered the draft WHO HIV strategy 2011–2015,2
1.
ENDORSES the global health sector strategy on HIV/AIDS, 2011–2015;3
2.
AFFIRMS the vision and strategic directions of the global health sector strategy on HIV/AIDS,
2011–2015 and that the global strategy aims to guide the health sector’s response to HIV/AIDS,
including recommended actions at country and global levels, as well as contributions to be made by
WHO;
3.
WELCOMES the alignment of the global health sector strategy on HIV/AIDS, 2011–2015 with
other strategies addressing related public health issues, including the UNAIDS strategy 2011–2015;4
4.
URGES Member States:
(1)
to adopt the global health sector strategy on HIV/AIDS, 2011–2015;
(2) to implement the strategy according to the four strategic directions to guide national
responses as described in the strategy;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Document A64/15.
3
See Annex 4 for the global health sector strategy on HIV/AIDS, 2011–2015.
4
Getting to zero: UNAIDS strategy 2011–2015. Geneva, UNAIDS, 2010.
RESOLUTIONS AND DECISIONS
5.
31
REQUESTS the Director-General:
(1) to give adequate support to implementation of the global health sector strategy on
HIV/AIDS, 2011–2015, including provision of support to Member States for country
implementation and reporting on progress on the health sector response to HIV/AIDS;
(2) to monitor and evaluate progress in implementing the global health sector strategy on
HIV/AIDS, 2011–2015, and to report on that progress, aligned with the reporting of other
United Nations agencies, through the Executive Board, to the Sixty-fifth, Sixty-seventh and
Sixty-ninth World Health Assemblies.
(Tenth plenary meeting, 24 May 2011 –
Committee A, sixth report)
WHA64.15
Cholera: mechanism for control and prevention1
The Sixty-fourth World Health Assembly,
Having considered the report on cholera;2
Recalling resolution WHA44.6 on cholera, which led to the establishment of the Global Task
Force on Cholera Control with the aim of providing support to Member States in reducing morbidity
and mortality associated with the disease and in diminishing its social and economic consequences;
Recognizing that cholera is not being sufficiently addressed despite its prevalence in epidemic
form in both endemic and non-endemic areas, causing suffering to millions, particularly among
vulnerable populations, with a disease burden estimated to be 3–5 million cases and 100 000–130 000
deaths per year;3
Reiterating that the spread of cholera is a consequence of natural disasters, the lack of an
adequate supply of safe potable water, deficient sanitation, poor hygiene, contamination of food,
unplanned human settlement, especially in urban areas, the absence of effective health systems,
inadequate health care, and poverty;
Acknowledging that effective public health interventions, such as proper and timely case
management, improved environmental management, improved hygiene and sanitation behaviour, and
access to and appropriate use of cholera vaccines, all depend on a solid system of surveillance and
health-care delivery and a coordinated programmatic and multisectoral approach that includes access
to appropriate health care, clean water and adequate sanitation, community involvement, open and
transparent sharing of epidemiological information, and sustained policy dialogue;
Recognizing also the importance of emergency preparedness planning, surveillance
strengthening, early response, and meeting relevant standards defined by the work of the Sphere
Project in emergencies;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Document A64/18.
3
Weekly epidemiological record, 2010, 85(13): 117–128.
32
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Noting that, in emergency health crises, and in emergencies where the situation threatens
sanitary conditions, WHO’s work as the humanitarian health cluster lead necessitates close
cooperation with UNICEF’s responsibilities as the lead of the WASH (water, sanitation and hygiene)
cluster;
Affirming that progress in achieving the health-related Millennium Development Goals, and
particularly access to safe drinking-water and sanitation under Goal 7 (Ensure environmental
sustainability), would decrease the occurrence and spread of cholera, and that improving prevention
and control of cholera will have a positive effect on other diarrhoeal diseases;
Recognizing further that control of cholera is entering a new phase with the development of
safe, effective and potentially affordable oral cholera vaccines, and that this approach is
complementary to, and should not substitute for, the existing effective prevention and control
measures that are based on improved access to potable water, sanitation and hygiene,
1.
URGES all Member States:1
(1) to consider health, hygiene, water, sanitation and environmental issues as integral and
interrelated parts of development policies and plans, and accordingly to allocate resources and
undertake action, including health and hygiene education and public information, in order to
prevent the risks of cholera epidemics occurring or to diminish such risks, giving due attention
to the situation and needs of population groups most at risk;
(2) to strengthen surveillance and reporting of cholera in accordance with the International
Health Regulations (2005), and to integrate the surveillance of cholera effectively into overall
surveillance systems by building local capacities for data collection and analysis and
encompassing information on crucial determinants such as water sources, sanitation coverage,
environmental conditions and cultural practices;
(3) to work towards mobilizing sufficient technical and financial resources for coordinated
and multisectoral measures for preparation, prevention and control of cholera, as well as other
diarrhoeal diseases, in both endemic and epidemic situations, within the framework of health
system strengthening and sector-wide approaches, and in the spirit of international solidarity;
(4) to involve the community and to scale up advocacy measures in view of the intersectoral
nature of the disease;
(5) to refrain from imposing on affected or at-risk countries any trade or travel restrictions
that cannot be justified on the grounds of public health concerns, in line with Article 43 of the
International Health Regulations (2005);
(6) to undertake planning for and give consideration to the administration of vaccines, where
appropriate, in conjunction with other recommended prevention and control methods and not as
a substitute for such methods;
1
And, where applicable, regional economic integration organizations.
RESOLUTIONS AND DECISIONS
2.
33
REQUESTS the Director-General:
(1) to strengthen and enhance measures to ensure that the Organization continues to respond
expeditiously and effectively to the needs of the countries affected by or at risk of outbreaks of
cholera;
(2) to revitalize the Global Task Force on Cholera Control and to strengthen WHO’s work in
this area, including improved collaboration and coordination among relevant WHO departments
and other relevant stakeholders;
(3) to strengthen the coordination of international assistance during cholera epidemics in
terms of equipment and human and financial resources, in order to ensure an effective and quick
response, and to prioritize close collaboration with other clusters including, but not limited to,
the WASH cluster and logistics, in order to maximize the effectiveness of the overall
multilateral humanitarian response;
(4) to provide technical support to countries for building their capacity to undertake effective
control and prevention measures, including surveillance, early warning and response, laboratory
capacity, risk assessment, case management, data collection and monitoring, and effective
vaccine deployment;
(5) to further promote research, and encourage surveillance, on the emergence of altered
variants and drug-resistant strains of Vibrio cholerae, as well as to consider safe and effective
innovations in oral rehydration therapy that can provide additional benefit in terms of the
treatment outcome;
(6) to promote ongoing interventions to change behaviour and food and water safety
measures, including training and advocacy programmes, in order to improve sanitary and
hygienic practices as critical components of cholera prevention and control;
(7) to continue to support further research on safe, efficacious and affordable cholera
vaccines, and to promote transfer of relevant vaccine manufacturing technologies to countries
affected by or at risk of cholera, in order to build capacity for the local production of cholera
vaccines;
(8) to develop updated and practical evidence-based policy guidelines, including on the
feasibility and assessment of the appropriate and cost-effective use of oral cholera vaccines in
low-income countries and on the definition of target groups;
(9) to liaise with relevant international funding agencies on possible support for introducing
effective cholera vaccines in low-income countries;
(10) to report to the Sixty-fifth World Health Assembly, through the Executive Board, on the
global cholera situation and to evaluate efforts made in cholera prevention methods and control.
(Tenth plenary meeting, 24 May 2011 –
Committee A, sixth report)
34
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
WHA64.16
Eradication of dracunculiasis1
The Sixty-fourth World Health Assembly,
Having considered the report on dracunculiasis;2
Recalling resolutions WHA39.21 and WHA42.29 on elimination of dracunculiasis and
WHA44.5, WHA50.35 and WHA57.9 on eradication of dracunculiasis;
Recalling also that health ministers of countries endemic for dracunculiasis in 2004 signed,
during the Fifty-seventh World Health Assembly, the Geneva Declaration for the Eradication of
Dracunculiasis by 2009;
Noting the resolutions on the eradication of dracunculiasis adopted by the Regional Committee
for Africa;3
Noting also with satisfaction the excellent results achieved by the countries where
dracunculiasis is endemic in decreasing the number of cases from an estimated 3.5 million in 1986 to
3190 reported cases in 2009 and less than 1800 reported cases in 2010;
Encouraged that only four countries remained endemic for dracunculiasis at the end of 2009, all
in sub-Saharan Africa, and that 187 countries and territories have been certified free of dracunculiasis
transmission;
Congratulating all parties concerned, particularly UNICEF and The Carter Center, for
increasing the availability of safe drinking-water, improving surveillance case detection and case
containment, strengthening other interventions and expanding public awareness of the disease,
1.
ENDORSES the strategy of intensified surveillance, case containment, use of cloth and pipe
filters, vector control, access to safe drinking-water, health education and community mobilization;
2.
CALLS ON the remaining Member States where dracunculiasis is endemic to intensify their
eradication efforts, including active surveillance in villages where the disease is endemic and
surveillance in dracunculiasis-free areas, prevention measures and political support at the highest
levels;
3.
CALLS ON Member States that have already been certified as being free from dracunculiasis
and those that are in the pre-certification stage to intensify surveillance for the disease and report the
results regularly, and to notify WHO within 24 hours of any case detected and the alleged country of
origin of the case;
4.
URGES Member States, UNICEF, The Carter Center and other appropriate partners to support
the remaining countries where dracunculiasis is endemic in their efforts to stop its transmission as
soon as possible, with, inter alia, provision of adequate resources for interrupting transmission and
eventual certification of eradication of the disease;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Document A64/20.
3
Resolutions AFR/RC38/R13, AFR/RC41/R2, AFR/RC43/R9, AFR/RC44/R8, and AFR/RC45/R8.
RESOLUTIONS AND DECISIONS
5.
35
REQUESTS the Director-General:
(1) to garner support for the remaining countries where dracunculiasis is endemic in their
efforts to stop its transmission as soon as possible, with, inter alia, provision of adequate
resources for interrupting transmission and certification of eradication of the disease;
(2) to support surveillance in dracunculiasis-free areas and countries until global certification
of eradication has been achieved;
(3) to monitor closely the implementation of this resolution and report progress, through the
Executive Board, to the Health Assembly every year until eradication of dracunculiasis has been
certified.
(Tenth plenary meeting, 24 May 2011 –
Committee A, sixth report)
WHA64.17
Malaria1
The Sixty-fourth World Health Assembly,
Having considered the report on malaria;2
Recalling resolutions WHA58.2 on malaria control and WHA60.18 that established World
Malaria Day;
Recognizing that increased global and national investments in malaria control have yielded
significant results in decreasing the burden of malaria in many countries, and that some countries are
moving towards elimination of malaria;
Aware that recent successes in prevention and control are fragile and can only be maintained
with sufficient investment to fund global malaria control efforts fully;
Realizing that current approaches to malaria prevention and control, when fully implemented in
an integrated manner, are highly effective, rapidly make an impact, and contribute to stronger health
systems and the achievement of the health-related Millennium Development Goals;
Acknowledging that full expansion of malaria control and prevention activities will need
adequately-resourced national programmes functioning within effective health systems that provide
for an uninterrupted supply of quality-assured commodities and services;
Conscious that many countries continue to have unacceptably high burdens of malaria and must
rapidly increase prevention and control efforts in order to reach the targets set by the Health Assembly
and the internationally agreed health-related goals contained in the United Nations Millennium
Declaration;
Cognizant that strategies need to be reoriented in countries that have reduced their disease
burden due to malaria in order to sustain those gains;
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Document A64/19.
36
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Recognizing also that artemisinin based fixed-dose combinations are highly preferable to loose
individual medicines that are co-blistered or co-dispensed;
Mindful that antimalarial prevention and control rely heavily on medicines and insecticides
whose utility is continuously threatened by the development of resistance of plasmodia to antimalarial
agents and of mosquitoes to insecticides;
Stressing that WHO and relevant technical partners should identify and address obstacles that
impede manufacturers of artemisinin-based combination therapy in malaria-endemic countries from
achieving prequalification;
Recognizing further the resolution adopted at the 18th Roll Back Malaria Board Meeting on
artemisinin-based combination therapy manufacturing in malaria-endemic countries,1
1.
URGES Member States:
(1) to keep malaria high on the political and development agendas, to advocate strongly for
adequate and predictable long-term financing for malaria control, and to sustain national
financial commitments for malaria control in order to accelerate implementation of the policies
and strategies recommended by WHO, thereby achieving Target 6.C of Millennium
Development Goal 6, and contributing to Millennium Development Goals 4 and 5 as well as
other targets set by the Health Assembly in resolution WHA58.2;
(2) to undertake comprehensive reviews of malaria programmes as an essential step in
developing strategic and operational plans for achieving and maintaining universal access to and
coverage of malaria interventions, notably:
(a) recommended vector-control operations for all people at risk, and maintenance of
effective coverage particularly through (i) replacement and continuous provision of longlasting insecticide-treated bednets, and targeted communication about their usage, and/or
(ii) regular application of indoor residual spraying with insecticides, in accordance with
WHO recommendations;
(b) prompt diagnostic testing of all suspected cases of malaria and effective treatment
with artemisinin-based combination therapy of patients with confirmed falciparum
malaria in both the public and private sectors at all levels of the health system, including
the community level, and to use the expansion of diagnostic services as an opportunity to
strengthen malaria surveillance;
(3) in order to sustain the advances in malaria control, to take immediate action to combat the
major threats, namely:
(a) resistance to artemisinin-based medicines, by strengthening regulatory services in
the public and private sectors, working to halt the use of oral artemisinin-based
monotherapies and substandard medicines not meeting WHO prequalification standards
or strict national regulatory authority standards, introducing quality-assurance
mechanisms, and improving supply-chain management for all malaria commodities and
services;
1
Resolution RBM/BOM/2010/RES.129.
RESOLUTIONS AND DECISIONS
37
(b) resistance to insecticides, by adopting best practices such as: rotation of
insecticides used for indoor residual spraying, and using insecticides approved for indoor
residual spraying from insecticide classes other than pyrethroids (and compounds sharing
cross-resistance with pyrethroids) when technically appropriate alternatives are available,
in areas where usage of insecticide-treated bednets is high;
(4) to use the expansion of interventions for malaria prevention and control as an entry point
for strengthening health systems, including laboratory services, maternal and child health
services at peripheral health facilities, integrated management of illnesses at the community
level, and timely and accurate surveillance;
(5) to maintain core national competencies for malaria control by sustaining a strong cadre of
malaria experts, including entomologists, at all levels of the health-care system, where
appropriate;
(6) to comply with existing commitments and international regulations on the use of
pesticides, in particular the Stockholm Convention on Persistent Organic Pollutants (Stockholm,
2004);
(7) to increase funding for research and development in malaria prevention, control and
treatment;
(8) to promote the scaling up of artemisinin-based combination therapy, where appropriate,
either as fixed-dose combinations or co-administration of two separate drugs, with a system to
ensure a high level of adherence to treatment, taking into account the local evidence on
effectiveness, cost–effectiveness, availability and affordability, regulatory capacity, budget
burden, feasibility and long-term sustainability;
2.
CALLS upon the international partners, including international organizations, financing bodies,
research institutions, civil society, and the private sector:
(1) to ensure adequate and predictable global funding so that the global malaria targets for
2015 can be met and malaria-control efforts can be sustained in order to contribute to attaining
the health-related Millennium Development Goals;
(2) to harmonize the provision of support to countries for implementing WHO-recommended
policies and strategies based on local endemicity of malaria, using commodities that meet WHO
prequalification standards or strict national regulatory authority standards, in order to secure
universal access to vector-control and other prevention measures, diagnostic testing of suspected
cases of malaria, and rational treatment of patients with confirmed malaria, as well as timely
malaria surveillance systems;
(3) to support initiatives for the discovery and development of new medicines and
insecticides to replace those whose usefulness is being lost through resistance, and to support
both basic research on innovative tools for control and elimination of malaria (including
vaccines) and operational research to overcome constraints limiting the expansion and practical
effectiveness of existing interventions;
(4) to collaborate with WHO in order to support countries in accomplishing malaria goals
and to progress to malaria’s elimination;
(5) to focus on particularly vulnerable populations in high-burden countries, people in fragile
situations, and tribal people threatened by forest malaria;
38
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
(6) to work together to support infrastructure development and the training of the
pharmaceutical manufacturers from countries endemic for malaria in order to increase access to
cost-competitive artemisinin-based combination therapies that meet international quality
standards, provided such assistance is made available in accordance with clear and transparent
protocols for the selection of manufacturers to receive this assistance, and that such assistance is
provided in a strategic, prioritized and transparent way;
3.
REQUESTS the Director-General:
(1) to support the development and updating of evidence-based norms, standards, policies,
guidelines and strategies for malaria prevention, control and elimination in order to chart a
course for reaching the 2015 malaria-related targets set by the Health Assembly and in the
Millennium Development Goals, and for responding to the rapidly declining burden of malaria;
(2) to monitor global progress in the control and elimination of malaria and provide support
to Member States in their efforts to collect, validate and analyse data from malaria surveillance
systems;
(3) to provide support to countries in defining their human resource needs and strengthening
human resource capacity for malaria and vector control at national, district and community
levels by revitalizing international training courses and subregional training networks and
promoting adequate systems of supervision, mentoring and continuing education;
(4) to provide support to Member States in identifying new opportunities for malaria control,
as well as combating major threats, notably plasmodial resistance to antimalarial agents and
mosquito resistance to insecticides, through the development and implementation of the Global
Plan for Artemisinin Resistance Containment and a global plan for the prevention and
management of insecticide resistance;
(5) to promote the transfer of technology to manufacturers of artemisinin-based combination
therapies in malaria-endemic countries and to strengthen their capacity to meet WHO
prequalification standards, provided such assistance is made available in accordance with clear
and transparent protocols for the selection of manufacturers to receive this assistance, and that
such assistance is provided in a strategic, prioritized and transparent way;
(6) to provide support, upon request, to national regulatory authorities to strengthen their
capacity in terms of monitoring compliance with good manufacturing practices and WHO
prequalification standards;
(7) to support Member States to continually monitor the progress of accessibility,
affordability and use of artemisinin-based combination therapy;
(8) to report to the Sixty-sixth and Sixty-eighth World Health Assemblies, through the
Executive Board, on implementation of this resolution.
(Tenth plenary meeting, 24 May 2011 –
Committee A, seventh report)
RESOLUTIONS AND DECISIONS
WHA64.18
39
Unaudited interim financial report on the accounts of WHO for the
year 2010
The Sixty-fourth World Health Assembly,
Having examined the unaudited interim financial report on the accounts of WHO for the
year 2010;1
Having noted the second report of the Programme, Budget and Administration Committee of the
Executive Board to the Sixty-fourth World Health Assembly,2
ACCEPTS the Director-General’s unaudited interim financial report for the year 2010.
(Tenth plenary meeting, 24 May 2011 –
Committee B, second report)
WHA64.19
Status of collection of assessed contributions, including Member States
in arrears in the payment of their contributions to an extent that would
justify invoking Article 7 of the Constitution
The Sixty-fourth World Health Assembly,
Having considered the fifth report of the Programme, Budget and Administration Committee of
the Executive Board to the Sixty-fourth World Health Assembly on the Status of collection of assessed
contributions, including Member States in arrears in the payment of their contributions to an extent
that would justify invoking Article 7 of the Constitution;3
Noting that, at the time of opening of the Sixty-fourth World Health Assembly, the voting rights
of Central African Republic, Comoros, Dominica, Guinea-Bissau, Somalia and Tajikistan were
suspended, and such suspension was to continue until the arrears of the Member States concerned had
been reduced, at the present or future Health Assemblies, to a level below the amount that would
justify invoking Article 7 of the Constitution;
Noting that Grenada, Guinea and Kyrgyzstan were in arrears at the time of the opening of the
Sixty-fourth World Health Assembly to such an extent that it was necessary for the Health Assembly
to consider, in accordance with Article 7 of the Constitution, whether or not the voting privileges of
those countries should be suspended; for Kyrgyzstan at the opening of the Sixty-fourth World Health
Assembly, and for the remaining two Member States at the opening of the Sixty-fifth World Health
Assembly,
DECIDES:
(1) that in accordance with the statement of principles set out in resolution WHA41.7 if, by
the time of the opening of the Sixty-fifth World Health Assembly, Grenada and Guinea were
still to be in arrears in the payment of their contributions to an extent that would justify invoking
Article 7 of the Constitution, their voting privileges shall be suspended as from the said
1
See documents A64/29 and A64/29 Add.1.
2
See documents A64/49 and A64/49 Corr.1.
3
See document A64/31.
40
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
opening; and in accordance with resolution WHA61.8 if, by the time of the opening of the
Sixty-fourth World Health Assembly, Kyrgyzstan were still to be in arrears in the payment of its
rescheduled assessments, its voting privileges shall be suspended automatically;
(2) that any suspension that takes effect as set out in paragraph (1) above shall continue at the
Sixty-sixth World Health Assembly and subsequent Health Assemblies, until the arrears of
Grenada, Guinea and Kyrgyzstan have been reduced to a level below the amount that would
justify invoking Article 7 of the Constitution;
(3) that this decision shall be without prejudice to the right of any Member to request
restoration of its voting privileges in accordance with Article 7 of the Constitution.
(Tenth plenary meeting, 24 May 2011 –
Committee B, second report)
WHA64.20
Special arrangements for settlement of arrears
The Sixty-fourth World Health Assembly,
Having considered the report by the Secretariat on the Status of collection of assessed
contributions;1
Noting that Ukraine has outstanding contributions;
Considering the request of Ukraine to reschedule the remaining balance of arrears under the
special arrangements for settlement of arrears,2
1.
DECIDES to allow Ukraine to keep its voting privileges at the Sixty-fourth World Health
Assembly on the following conditions:
Ukraine shall pay its outstanding arrears of assessed contributions, totalling US$ 26 395 036,
over 10 years from 2013 to 2022, as set out below, in addition to payment of its annual
assessment for the current year;
Year
1
See documents A64/31 and A64/51.
2
See document A64/32.
US$
2013
2 639 504
2014
2 639 504
2015
2 639 504
2016
2 639 504
2017
2 639 504
2018
2 639 504
2019
2 639 504
2020
2 639 504
RESOLUTIONS AND DECISIONS
Year
41
US$
2021
2 639 504
2022
2 639 500
Total
26 395 036
2.
DECIDES that, in accordance with Article 7 of the Constitution, voting privileges shall be
automatically suspended if Ukraine does not meet the requirements laid down in paragraph 1 above;
3.
REQUESTS the Director-General to report to the Sixty-fifth World Health Assembly on the
prevailing situation;
4.
REQUESTS the Director-General to communicate this resolution to the Government of
Ukraine.
(Tenth plenary meeting, 24 May 2011 –
Committee B, second report)
WHA64.21
Scale of assessments for 2012–2013
The Sixty-fourth World Health Assembly,
Having considered the report on the scale of assessments for 2012–2013,1
ADOPTS the scale of assessments of Members and Associate Members for the biennium
2012–2013 as set out below:
Members and
Associate Members
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
1
Document A64/33.
WHO scale
for 2012–2013
%
0.0040
0.0100
0.1280
0.0070
0.0100
0.0020
0.2870
0.0050
1.9331
0.8511
0.0150
0.0180
0.0390
0.0100
0.0080
0.0420
1.0751
0.0010
42
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Members and
Associate Members
Benin
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic People’s Republic of
Korea
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
WHO scale
for 2012–2013
%
0.0030
0.0010
0.0070
0.0140
0.0180
1.6111
0.0280
0.0380
0.0030
0.0010
0.0030
0.0110
3.2072
0.0010
0.0010
0.0020
0.2360
3.1892
0.1440
0.0010
0.0030
0.0010
0.0340
0.0100
0.0970
0.0710
0.0460
0.3490
0.0070
0.0030
0.7361
0.0010
0.0010
0.0420
0.0400
0.0940
0.0190
0.0080
0.0010
0.0400
0.0080
0.0040
0.5660
6.1234
0.0140
0.0010
0.0060
8.0186
0.0060
RESOLUTIONS AND DECISIONS
Members and
Associate Members
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People’s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia (Federated States of)
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
WHO scale
for 2012–2013
%
0.6910
0.0010
0.0280
0.0020
0.0010
0.0010
0.0030
0.0080
0.2910
0.0420
0.5340
0.2380
0.2330
0.0200
0.4980
0.3840
4.9994
0.0140
12.5309
0.0140
0.0760
0.0120
0.0010
0.2630
0.0010
0.0010
0.0380
0.0330
0.0010
0.0010
0.1290
0.0650
0.0900
0.0030
0.0010
0.2530
0.0010
0.0030
0.0170
0.0010
0.0010
0.0110
2.3562
0.0010
0.0030
0.0020
0.0040
0.0580
0.0030
0.0060
43
44
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Members and
Associate Members
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Korea
Republic of Moldova
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
WHO scale
for 2012–2013
%
0.0080
0.0010
0.0060
1.8551
0.2730
0.0030
0.0020
0.0780
0.0010
0.8711
0.0860
0.0820
0.0010
0.0220
0.0020
0.0070
0.0900
0.0900
0.8281
0.5110
0.0010
0.1350
2.2602
0.0020
0.1770
1.6021
0.0010
0.0010
0.0010
0.0010
0.0010
0.0030
0.0010
0.8301
0.0060
0.0370
0.0020
0.0010
0.3350
0.1420
0.1030
0.0010
0.0010
0.3850
3.1772
0.0190
0.0100
0.0030
0.0030
1.0641
RESOLUTIONS AND DECISIONS
Members and
Associate Members
Switzerland
Syrian Arab Republic
Tajikistan
Thailand
The former Yugoslav Republic of
Macedonia
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain
and Northern Ireland
United Republic of Tanzania
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Yemen
Zambia
Zimbabwe
Total
45
WHO scale
for 2012–2013
%
1.1301
0.0250
0.0020
0.2090
0.0070
0.0010
0.0010
0.0010
0.0010
0.0440
0.0300
0.6170
0.0260
0.0010
0.0060
0.0870
0.3910
6.6045
0.0080
22.0000
0.0270
0.0100
0.0010
0.3140
0.0330
0.0100
0.0040
0.0030
100.0000
(Tenth plenary meeting, 24 May 2011 –
Committee B, second report)
WHA64.22
Amendments to the Financial Regulations1
The Sixty-fourth World Health Assembly,
Having considered the report on amendments to the Financial Regulations;2
Recalling resolution WHA60.9 on amendments to the Financial Regulations and Financial
Rules: introduction of International Public Sector Accounting Standards,
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
Document A64/34.
46
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
ADOPTS the amendments to Financial Regulations 14.1, 14.8 and 14.9 to be effective as from
1 January 2012.1
(Tenth plenary meeting, 24 May 2011 –
Committee B, second report)
WHA64.23
Appointment of the External Auditor
The Sixty-fourth World Health Assembly,
Having considered the report on the appointment of the External Auditor;2
1.
RESOLVES that the Chairperson of the Commission on Audit of the Philippines be appointed
External Auditor of the accounts of the World Health Organization as well as the non-consolidated
affiliated entities and partnerships for the period 2012–2015, and that the Chairperson audits in
accordance with the principles incorporated in Regulation XIV of the Financial Regulations and the
Appendix to the Financial Regulations, provided that, should the necessity arise, the Chairperson may
designate a representative to act in the Chairperson’s absence;
2.
EXPRESSES its thanks to the Comptroller and Auditor-General of India for the work
performed for the Organization in the audit of the accounts for the financial periods
2008–2009 and 2010–2011.
3.
FURTHER REQUESTS the Director-General to establish contractual terms and conditions
between the Organization and the appointed External Auditor to cover the modalities of the External
Auditor’s work in fulfilling its mandate, with particular reference to the additional requirements posed
by the introduction of the International Public Sector Accounting Standards as of 2012.
(Tenth plenary meeting, 24 May 2011 –
Committee B, second report)
WHA64.24
Drinking-water, sanitation and health3
The Sixty-fourth World Health Assembly,
Having considered the report on strategies for the safe management of drinking-water for human
consumption;4
Recalling the Declaration of Alma-Ata on Primary Health Care and the various resolutions that
stress the role of improving safe drinking-water, sanitation facilities and hygiene practices in primary
health care, environmental health, prevention of waterborne diseases, protection of high-risk
communities, infant and young child nutrition, including resolutions WHA39.20, WHA42.25,
WHA44.28, WHA45.31, WHA35.17, WHA51.28 and WHA63.23, as well as resolution WHA64.15
1
See Annex 5 for the amended Financial Regulations.
2
Documents A64/35 and A64/35 Corr.1.
3
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
4
Document A64/24.
RESOLUTIONS AND DECISIONS
47
on cholera: mechanisms for control and prevention, and resolution WHA64.16 on eradication of
dracunculiasis;
Recalling further Target C of Goal 7 (Ensure environmental sustainability) of the Millennium
Development Goals, which calls for halving by 2015, the proportion of the population without
sustainable access to safe drinking-water and basic sanitation; and the importance of this target for the
achievement of other goals, particularly Goals 4 (Reduce child mortality), 5 (Improve maternal health)
and 6 (Combat HIV/AIDS, malaria and other diseases);1
Recognizing that between 1990 and 2008 an estimated 1770 million people gained access to
improved sources of drinking-water and 1260 million gained access to improved sanitation, but deeply
concerned that by the end of 2008, 884 million people still lacked access to improved water sources
and over 2600 million people did not have access to improved sanitation;
Noting the multiple health benefits and economic advantages of a broad public health approach
through the expansion of access to safe drinking-water and sanitation, integrating household
interventions, a more effective use of resources and the early incorporation of health considerations in
the planning and design of water resources development, and recognizing the importance of pursuing
these issues for the achievement of strategic objective 8 of the Medium-term strategic plan
2008–2013;
Recalling the International Decade for Action, “Water for Life” 2005–2015, proclaimed by the
United Nations General Assembly in resolution 58/217; the International Year of Sanitation, 2008,
declared in resolution 61/192; as well as the follow-up resolution 65/153, which called upon all
Member States to support the global effort to realize “Sustainable sanitation: the five-year-drive to
2015”; and also recalling that water quality was the theme of the United Nations World Water Day
2010;
Recalling further United Nations General Assembly resolution 64/292, which recognized the
right to safe and clean drinking-water and sanitation as a human right that is essential for the full
enjoyment of life and all human rights, and Human Rights Council resolution A/HRC/RES/15/9,
which affirmed that the human right to safe drinking-water and sanitation is derived from the right to
an adequate standard of living and inextricably related to the right to the highest attainable standard of
physical and mental health, as well as the right to life and human dignity;
Noting with interest the efforts made to improve access to safe drinking-water, basic sanitation
and to promote good personal and domestic hygiene practices that contribute to a sustainable approach
to fight sanitation- and water-related diseases such as cholera and diarrhoea, which claimed the lives
of 2.5 million people in 2008, among whom were 1.3 million children under the age of five years;
Also noting the water, sanitation and hygiene components in the seven-point strategy agreed by
WHO and UNICEF for comprehensive diarrhoea control, which include the promotion of hand
washing with soap, household water treatment and safe storage and community-wide sanitation
promotion;
Noting that millions of people are exposed to dangerous levels of biological contaminants and
chemical pollutants in their drinking-water, partly due to the inadequate management of urban,
industrial or agricultural wastewater;
1
See United Nations General Assembly resolution 65/1.
48
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Recognizing WHO’s major normative role in issues of water and health, its key role in
monitoring progress regarding water supply and sanitation as well as its promotional and
capacity-building roles for water safety plans, sanitation safety plans, water and sanitation in health
care, schools and other public buildings and settings, and safe management of medical waste;
Noting that global driving forces, including population growth, urbanization and climate
change, are expected to affect significantly the availability and quality of access to water and
sanitation services and of freshwater resources and the need for water resources development for other
purposes, which in themselves carry potential health risks, and noting that a response to these trends
requires an intersectoral approach mainstreaming health and environmental issues in national sectoral
policies through integrated water resources management and strengthened institutional arrangements
to prevent and reduce the incidence of sanitation- and water-related diseases;
Noting that over the last decade almost 2000 million people were victims of natural disasters,
including floods and droughts, that act as key contributors to sanitation- and water-related diseases;
Recognizing also the need, in emergency situations, to develop prevention tools and specific
actions for supplying drinking-water and sanitation as well as the leading role of both WHO in the
health cluster and UNICEF in the nutrition and WASH (water, sanitation and hygiene) clusters in
emergency operations,
1.
URGES Member States:
(1) to develop and strengthen, with all stakeholders, national public health strategies, so that
they highlight the importance of safe drinking-water, sanitation and hygiene as the basis for
primary prevention, based on an integrated approach of sectoral planning processes, policies,
programmes and projects regarding water and sanitation, guided by an effective interministerial
coordination mechanism at appropriate level, designating clear responsibilities across relevant
ministries and institutions;
(2) to promote new approaches to community education, empowerment, participation and
awareness creation involving actively their leaders and civil society, with a view to having a
specific impact, particularly on women, children, youth, indigenous people and vulnerable and
the poorest people, acknowledging and encouraging good practices;
(3) to ensure that national health strategies contribute to the realization of water- and
sanitation-related Millennium Development Goals, and support the progressive realization of
the human right to water and sanitation that entitles everyone, without discrimination, to water
and sanitation that is sufficient, safe, acceptable, physically accessible and affordable for
personal and domestic uses;
(4) to strengthen the intersectoral policy frameworks and institutional mechanisms for
integrated management of water- and sanitation-related health hazards and risks, including
health impact assessment, strategic extension of drinking-water and sanitation systems and
services, and environmental management to protect health in water resources and wastewater
management projects;
(5) to mobilize their efforts, in consultation with bilateral and multilateral partners and in
close coordination with responsible local authorities, to prioritize and implement the reduction
of disparities that exist between urban, periurban and rural areas as regards: access to drinkingwater at home as well as from other improved sources; improved sanitation facilities; and
hygiene;
RESOLUTIONS AND DECISIONS
49
(6) to offer appropriate facilities for access to safe drinking-water, sanitation and hand
washing with soap in health-care establishments, schools and other public buildings and
settings, as well as advocacy and training tools on safe water, sanitation and hygiene practices
for those who operate and use these establishments;
(7) to improve cooperation between the appropriate authorities and stakeholders, including in
transboundary settings, to establish, implement and maintain efficient systems for assessing
water quality, regularly communicating relevant, easily accessible information and responding
to water quality issues;
(8) to ensure, in particular, the sustainability of comprehensive and harmonized national
and/or local water and sanitation-related monitoring systems and early warning tools in order to
prevent and control sanitation- and water-related diseases as well as to develop emergency
preparedness and action plans, particularly in the case of natural disasters and humanitarian
emergencies;
(9) to work to strengthen, as necessary, the establishment, implementation and quality control
of water safety plans and contribute to the development of sanitation safety plans, in
collaboration with the WHO collaborating centres, WHO-hosted networks (drinking-water
regulators, operation and maintenance, household water treatment and safe storage,
management of small-community water supplies) and associations in official relations with
WHO;
2.
REQUESTS the Director-General:
(1) to continue calling the attention of the international community and decision-makers to
the importance of primary prevention as a key goal, and the major impact of safe drinkingwater, sanitation and hygiene on global public health, national economies, and the achievement
of the Millennium Development Goals;
(2) to formulate a new, integrated WHO strategy for water, sanitation and health including a
specific focus on water quality and monitoring issues, and on the promotion of a change in
sanitation and hygiene behaviour, taking into account context-specific requirements with a view
to encouraging the establishment of preventive measures, as well as rapid analysis techniques to
guarantee the quality of drinking-water and avoid the adverse health impacts of water resources
development;
(3) to strengthen WHO’s collaboration with all relevant UN-Water members and partners, as
well as with other relevant organizations promoting access to safe drinking-water, sanitation and
hygiene services, so as to set an example of effective intersectoral action in the context of
WHO’s involvement in the United Nations Delivering as One initiative, and WHO’s
cooperation with the United Nations Special Rapporteur on the human right to safe drinkingwater and sanitation, with a view to improving the realization of that human right;
(4) to strengthen the WHO/UNICEF Joint Monitoring Programme capacities to fulfil its
mandate of monitoring progress towards the international drinking-water and sanitation
development goals, and to serve as a platform for the generation of new sanitation and water
indicators, including water quality and other relevant parameters at appropriate levels;
(5) to continue to support existing regional initiatives such as the United Nations Economic
Commission for Europe Protocol on Water and Health, which is an instrument of reference for
safe water management and the protection of human health, and to encourage the creation of
similar instruments dedicated to sustainable water management and the reduction of sanitation-
50
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
and water-related diseases in other regions, as well as continue to encourage relevant regional
initiatives such as the WHO/UNEP Libreville Declaration on Health and Environment (2010) or
the WHO Parma Declaration on Environment and Health (2010);
(6) to develop, in coordination with bilateral and multilateral partners, Member States’
capacities by providing guidelines and technical support to develop, implement, monitor and
evaluate national action plans for the sustainable management, operation and maintenance of
safe drinking-water supply and sanitation systems and services;
(7) to further support Member States’ capacities in building and maintaining adapted
information and monitoring systems in order to facilitate appropriate and streamlined reporting
to relevant global monitoring mechanisms including the World Health Statistics, the
WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation and the
UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water;
(8) to increase technical assistance to countries by facilitating training and adult learning
programmes for staff in charge of maintaining catchments, treatment and distribution facilities,
and water and sanitation networks, as well as for staff and laboratories in charge of water
quality monitoring, while encouraging the dissemination of best practices for household water
treatment, especially where central water treatment or water supplies are deficient or not
available;
(9) to promote partnerships for risk reduction in drinking-water installations and safe supply
of drinking-water and methods to gather and disseminate the best practices and experiences in
increasing access to safe drinking-water, sanitation and personal and domestic hygiene, in
particular for the poorest populations, in health emergencies or during natural disasters;
(10) to report on progress in implementing this resolution, through the Executive Board, to the
Sixty-sixth World Health Assembly.
(Tenth plenary meeting, 24 May 2011 –
Committee B, third report)
WHA64.25
Salaries of staff in ungraded posts and of the Director-General
The Sixty-fourth World Health Assembly,
Having considered the reports on the amendments to the Staff Regulations and Staff Rules;1
Noting the recommendations of the Executive Board with regard to remuneration of staff in
ungraded posts and of the Director-General,
1.
ESTABLISHES the salaries of Assistant Directors-General and Regional Directors at
US$ 185 809 gross per annum before staff assessment, resulting in a modified net salary of
US$ 133 776 (dependency rate) or US$ 121 140 (single rate);
2.
ESTABLISHES the salary of the Deputy Director-General at US$ 204 391 gross per annum
before staff assessment, resulting in a modified net salary of US$ 145 854 (dependency rate) or
US$ 131 261 (single rate);
1
Document A64/38.
RESOLUTIONS AND DECISIONS
51
3.
ESTABLISHES the salary of the Director-General at US$ 251 188 gross per annum before staff
assessment, resulting in a modified net salary of US$ 176 272 (dependency rate) or US$ 156 760
(single rate);
4.
DECIDES that those adjustments in remuneration shall take effect on 1 January 2011.
(Tenth plenary meeting, 24 May 2011 –
Committee B, third report)
WHA64.26
International Agency for Research on Cancer: amendments to Statute
The Sixty-fourth World Health Assembly,
Having considered the report on the International Agency for Research on Cancer: amendments
to Statute;1
Considering the amendment to Article VIII of the Statute of the International Agency for
Research on Cancer adopted by the Governing Council at its Fifty-third session;
Considering the provisions of Article X of the Statute of the Agency,
ACCEPTS the following amendment to the Statute of the Agency, which shall enter into force
forthwith:
Article VIII – Finance
[Paragraphs (1) through (7), inclusive, of Article VIII are unchanged.]
(8) The funds and assets of the Agency shall be accounted for separately from the funds and
assets of the World Health Organization and administered in accordance with the financial
regulations adopted by the Governing Council.
(Tenth plenary meeting, 24 May 2011 –
Committee B, third report)
WHA64.27
Child injury prevention2
The Sixty-fourth World Health Assembly,
Having considered the report on child injury prevention;3
Recalling resolution WHA57.10 on road safety and health, which affirmed that road traffic
injuries constitute a major public health problem that required coordinated international efforts;
1
Document A64/43.
2
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
3
Document A64/23.
52
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Recalling also that the Health Assembly in resolution WHA57.10 accepted the invitation by the
United Nations General Assembly for WHO to act as a coordinator on road safety issues within the
United Nations system, working in close collaboration with the United Nations regional commissions;
Further recalling resolution WHA60.22 on health systems: emergency-care systems, which
recognized that improved organization and planning for provision of trauma and emergency care is an
essential part of integrated health-care delivery, and resolution WHA58.23 on disability, including
prevention, management and rehabilitation, which urged Member States to take all necessary steps for
the reduction of risk factors contributing to disabilities in childhood;
Acknowledging the responsibilities to ensure safety in the care and protection of children
affirmed in the Convention on the Rights of the Child (1989), in the International Labour Organization
Convention 182 (1999) and in the International Labour Organization Convention 138 (1973), and further
acknowledging the responsibilities to protect persons with disabilities set out in the Convention on the
Rights of Persons with Disabilities (2006) particularly in developing, low- and middle-income
countries where there exists a significant burden of child injuries;
Recognizing that child injuries are a major threat to child survival and health, that they are a
neglected public health problem with significant consequences in terms of mortality, morbidity,
quality of life, and social and economic costs, and that in the absence of urgent action this problem
will hamper attainment of the Millennium Development Goals, particularly in developing, low- and
middle-income countries, where there exists a significant burden of child injuries;
Recognizing that the leading causes of child death from unintentional injury include road traffic
injury, drowning, fire-related burns, falls and poisoning. In some regions of the world, drowning is
responsible for about half of the total number of child injury deaths; context-specific preventive
measures including safe environment, safety products, safety management and awareness raising are
crucial;
Further recognizing that multisectoral approaches to preventing child injuries and limiting their
consequences through implementation of evidence-based interventions have resulted in dramatic and
sustained reductions in child injury in countries that have made concerted efforts;
Welcoming the joint WHO/UNICEF World report on child injury prevention1 and its
recommendations for public health policy and programming;
Considering that existing programmes on child survival and child health and development
should introduce child injury prevention strategies, ensuring these are an integrated part of child health
services, and that the success of child health programmes should not only be gauged by the use of
traditional measures of infectious disease mortality but also by indicators of fatal and non-fatal injury,
1.
URGES Member States:
(1) to prioritize the prevention of child injury among child issues and ensure that intersectoral
coordination mechanisms necessary to prevent child injury are established or strengthened;
(2) to continue and, if necessary, to strengthen the fulfilment of their obligations under the
Convention on the Rights of the Child (1989) to respect, protect and fulfil the rights of children
1
World report on child injury prevention, Geneva, World Health Organization, and New York, United Nations
Children’s Fund, 2008.
RESOLUTIONS AND DECISIONS
53
to the highest attainable standard of health and to take all appropriate legislative, administrative,
social and educational measures to protect children from injury;
(3) to ensure that funding mechanisms for relevant programmes, including health
programmes, cover child injury and prevention, emergency care, pre-hospital care, treatment
and rehabilitation services;
(4) to implement, as appropriate, the recommendations of the WHO/UNICEF World report
on child injury prevention, including, if not already in place, the assignation of a leadership role
to a government agency or unit for child injury prevention and the appointment of a focal
person for injury prevention, ensuring that such leadership facilitates collaboration between
relevant sectors of government, communities and civil society; and, according to national needs,
the key strategies identified in the World report as effective interventions for preventing child
injury; and to monitor and evaluate the impact of these interventions;
(5) to integrate child injury prevention in national child development programmes and in
other relevant programmes, and to establish multisectoral coordination and collaboration
mechanisms, in particular ensuring that prevention of child injury is accorded appropriate
importance within programmes for child survival and health;
(6) to ensure that national data collection across relevant sectors or surveillance systems
quantifies the demographic, socioeconomic and epidemiological profile of the burden of, risk
factors for, and costs of child injury, and to ensure that the resources available are
commensurate with the extent of the problem;
(7) to develop and implement a multisectoral policy and plan of action, where necessary, that
contain realistic targets for child injury prevention and include promotion of standards and
codes on the prevention of child labour, as well as on legal adolescent employment, product
safety, school and play spaces, transportation, construction regulations and laws, and that either
stand alone, or are incorporated within the national child health policy or plan;
(8) to enforce and, if necessary, strengthen the existing laws and regulations relevant to the
prevention of child injury;
(9) to strengthen emergency and rehabilitation services and capacities, including firstresponse teams, acute pre-hospital care, management at health facilities, and suitable
rehabilitation programmes for injured or disabled children;
(10) to define priorities for research, taking into consideration the WHO/UNICEF World
report on child injury prevention, and working closely with research and development
communities, including relevant manufacturers and distributors of safety products;
(11) to raise awareness and health literacy, in particular on child safety, among parents,
children, employers and relevant professional groups, as well as among all members of society,
about risk factors for child injury, especially transport, including the use of “cell” phones and
other such mobile devices while driving, workplace hazards, water and fire hazards, and lack of
child supervision and protection of children, and to advocate dedicated child injury prevention
programmes;
54
2.
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
REQUESTS the Director-General:
(1) to collaborate with Member States in improving data collection and analysis systems for
child injuries and in establishing science-based public health policies and programmes for
preventing and mitigating the consequences of child injury;
(2) to collaborate with organizations of the United Nations system, international development
partners and nongovernmental organizations to establish a network to ensure effective
coordination and implementation of activities for child injury prevention in low- and
middle-income countries;
(3) to encourage research that expands the evidence base for interventions to prevent child
injuries and mitigate their consequences, and that evaluates the effectiveness of such
interventions through collaborating centres and other partners, including translation into
affordable safety products, policy interventions and effective implementation;
(4) to facilitate the adaptation and transfer of knowledge on measures and instruments to
prevent child injury, from developed to developing settings;
(5) to support Member States in developing and implementing child injury prevention
measures;
(6) to provide additional support to national injury prevention focal persons by organizing
regular global and regional meetings and providing technical assistance;
(7) to provide technical support for strengthening systems and capacities for emergency and
rehabilitation services;
(8) to collaborate with Member States, organizations in the United Nations system, and
international development partners and nongovernmental organizations in order to mobilize
resources and to augment the capacities needed to prevent child injury and undertake related
rehabilitation programmes; to organize advocacy activities for governments of Member States;
and to raise awareness that, in the absence of urgent action, this problem will hamper attainment
of the Millennium Development Goals, particularly in developing, low- and middle-income
countries where there exists a significant burden of child injuries;
(9) to invest more in building institutional and individual capacities among Member States so
that they are able to develop cost-effective interventions at national and subnational levels;
(10) to report progress made in implementing this resolution, through the Executive Board, to
the Sixty-seventh World Health Assembly.
(Tenth plenary meeting, 24 May 2011 –
Committee B, fourth report)
RESOLUTIONS AND DECISIONS
WHA64.28
55
Youth and health risks1
The Sixty-fourth World Health Assembly,
Having considered the report on youth2 and health risks, which highlights the immediate and
long-term effects of health risks on young people;3
Recalling the resolutions that directly address issues concerning young people: WHA38.22 on
maturity before childbearing and promotion of responsible parenthood; WHA42.41 on the health of
youth; WHA56.21 on the strategy for child and adolescent health and development, WPR/RC39.R12
Rev.1 on adolescent health; EM/RC43/R.11 on health education of adolescents; AFR/RC51/R3 on
adolescent health: a strategy for the African Region; EUR/RC55/R6 on the European strategy for child
and adolescent health and development; and CD48.R5 on the Pan American regional strategy for
improving adolescent and youth health;
Recalling also the right of everyone, including adolescents and youth, to the enjoyment of the
highest attainable standard of physical and mental health, also recalling the International Covenant on
Economic, Social and Cultural Rights, the United Nations Convention on the Rights of the Child, the
United Nations Convention on the Elimination of All Forms of Discrimination against Women and
other international and regional human rights instruments, and emphasizing the need to promote the
equality of young women and men and respect for diversity;
Recognizing that health is not only the absence of disease or infirmity, but a state of complete
physical, mental and social well-being as articulated in the Constitution of the World Health
Organization;
Acknowledging the fact that the 1800 million young people globally – one quarter of all people
living in the world are between the ages of 10 and 24 years – make up the largest cohort in history,
thereby representing an extraordinary opportunity to shape the world’s social, economic and health
futures;
Recognizing also that the 2.6 million annual deaths among young people are generally
preventable and that their current health behaviours and conditions can compromise both their existing
and future health as well as the health of future generations;
Mindful also that heterogeneity of the youth population and their circumstances renders some
young people, for example adolescent girls, more vulnerable than others to negative health outcomes;
Emphasizing the importance of promoting healthy lifestyles, such as participation in physical
activity and sport, a healthy diet, and physical education, for young people;
Acknowledging also the attention given to young people in resolutions dealing with the
population at large: resolution WHA56.1 on the WHO Framework Convention on Tobacco Control;
resolution WHA63.13 on the Global strategy to reduce the harmful use of alcohol; resolution
WHA57.17 on the Global strategy on diet, physical activity and health; resolution WHA63.14 which
1
See Annex 6 for the financial and administrative implications for the Secretariat of this resolution.
2
WHO defines adolescents as between 10 and 19 years and young people as 10–24 years of age. The United Nations
defines youth as those persons between 15 and 24 years.
3
Document A64/25.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
endorsed the recommendations on the marketing of foods and non-alcoholic beverages to children;
resolution WHA61.14 on the implementation of the global strategy for the prevention and control of
noncommunicable diseases; resolution WHA57.12 on the strategy on reproductive health; the UNAIDS
strategy 2011–2015; resolution WHA59.19 on the global strategy for the prevention and control of
sexually transmitted infections; resolution WHA64.14 on the global health sector strategy on
HIV/AIDS, 2011–2015; the United Nations Decade of Action for Road Safety, 2011–2020; resolution
WHA60.22 on health systems: emergency-care systems; and the recommendations contained in the
World report on violence and health that were taken note of in resolution WHA56.24;
Recognizing further the roles of the organizations and programmes in the United Nations
system, such as ILO, UNESCO, UNICEF, UNHCR, UNFPA and UNAIDS, as well as the
International Organization for Migration, to address youth health risks and in influencing the
determinants of youth health;
Taking note of the importance of addressing social determinants of youth health, social
protection mechanisms that ensure the social inclusion, education and employment of youth, and the
Guanajuato Declaration, resulting from the World Youth Conference (Leon, Guanajuato, Mexico,
25–27 August 2010) and which called for increased investments in policies and programmes across
sectors and national development plans, with the meaningful participation of young people, following
the World Programme of Action for Youth to the Year 2000 and beyond;1
Cognizant that the United Nations World Programme for Action on Youth to the Year 2000 and
beyond1 encourages governments to develop comprehensive sexual and reproductive health-care
services and provide young people with age-appropriate access to those services including, inter alia,
education and services in family planning as set out in the programmes of action from the International
Conference on Population and Development (1994), the World Summit for Social Development (1995)
and the Fourth World Conference on Women (1995); ensuring that adolescents have age-appropriate
information about, access to and choice of, the widest possible range of safe, effective modern
methods of family planning; and to provide adolescents with comprehensive education on human
sexuality, on sexual and reproductive health and gender equality so as to enable them to deal in a
positive and responsible way with their sexuality;
Mindful in addition that meeting the indicators and targets related to young people is crucial for
attaining six of the eight Millennium Development Goals (Goals 1, 2, 3, 4, 5 and 6), and that paying
specific attention to young people contributes to achieving the aims of recent global health initiatives
such as the United Nations Secretary General’s Global Strategy for Women’s and Children’s Health
and UNAIDS’ Universal access to HIV/AIDS prevention, treatment, care and support;
Recognizing also the opportunities to pay specific attention to the health needs of adolescents
and youth during the forthcoming United Nations General Assembly high-level meetings on
HIV/AIDS, on youth and on the prevention and control of noncommunicable diseases;
Acknowledging further the capacity of young people to participate and lead in health and
development and the leadership they demonstrate in using and developing innovative technologies to
meet global and local challenges to their health and development,
1.
REAFFIRMS WHO’s strategies that address the major health risks facing youth and include
specific interventions for this age group;
1
United Nations General Assembly resolution 50/81.
RESOLUTIONS AND DECISIONS
57
2.
URGES Member States, in accordance with their national laws and regulations, to accelerate
action, as appropriate, and develop policies and plans to address the main determinants of health
affecting young people, including health-related behaviours and their impact on health at later stages
in life by:
(1) adopting national health policies and strategies that contain specific targets and indicators
on relevant determinants including assets, and outcomes of youth health and well-being;
(2) reviewing and revising policies in health and other areas with a view to including
measures to protect young people from harm (e.g. early child-bearing, sexual exploitation and
violence, use of illicit substances and tobacco, harmful use of alcohol, lack of physical activity,
unhealthy diet and obesity, road traffic and other injuries, and mental health problems);
(3) reviewing and revising policies in health and other areas to eliminate all forms of
discrimination experienced by youth;
(4) putting in place systems for health management information and vital registration that
provide up-to-date age- and sex-specific data, given the existing gap in the data regarding young
people’s health;
(5) promoting the responsiveness of the health system to adolescents’ needs, including health
workforce development and financing in order to remove barriers to access to youth-friendly
health-care services;
(6) providing access to contraception; reproductive health-care services; prevention,
treatment and care of HIV/AIDS and sexually transmitted infections and associated support;
mental health services; and trauma care;
(7) promoting access to accurate information and evidence-based approaches that promote
healthy behaviour, for example health information on sexual and reproductive health;
(8) promoting collaboration across sectors at all levels on young people’s health including
aspects related to health in sectors such as education, social inclusion, social and physical
environments, employment, and the media, and with civil society organizations and the private
sector, as appropriate;
(9) involving different actors, such as families, communities and youth themselves, in
addressing determinants and health risks of young people, and mobilizing stakeholders in order
to detect and help young people at risk or with a disadvantaged background;
(10) supporting the role of young people, with special attention to youth organizations, with a
view to facilitating young people’s empowerment and participation in influencing their
environments and shaping public policy;
3.
ENCOURAGES multilateral and bilateral donors, international financial institutions and
international development partners to support Member States to carry out these efforts, including
through the provision of financial and technical support, as appropriate;
4.
REQUESTS the Director-General:
(1) to ensure that the appropriate priority is accorded within the Secretariat, as well as the
necessary commitment, effective coordination and adequate resources in order to specify further
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
and expand the implementation of existing strategies as they apply to young people, and to
regularly monitor the results of such action on adolescents’ health;
(2) to address the health risks of adolescents and young people in the next Medium-term
strategic plan across programmes and levels of the Secretariat in order to provide sufficient
technical support to Member States;
(3) to identify knowledge gaps and facilitate research that will strengthen the evidence base
needed to establish, deliver and monitor effective and age- and gender-appropriate programmes
for adolescents and youth;
(4) to continue to collaborate, as appropriate, with organizations in the United Nations
system, civil society, and the private sector, that have a bearing on young people’s health;
(5) to strengthen the Secretariat’s capacity to provide sufficient technical support on youth
health to Member States, in particular health authorities, including strengthening the capacity of
WHO centres such as the WHO Mediterranean Centre for Health Risk Reduction;
(6) to promote the participation and empowerment of young people as key stakeholders in
health development, including in the work of the Organization;
(7) to periodically report on the health of young people and the implementation of this
resolution, through the Executive Board, to the World Health Assembly, with the first report
being to the Sixty-seventh World Health Assembly.
(Tenth plenary meeting, 24 May 2011 –
Committee B, fourth report)
DECISIONS
WHA64(1)
Composition of the Committee on Credentials
The Sixty-fourth World Health Assembly appointed a Committee on Credentials consisting of
delegates of the following Member States: Barbados, Costa Rica, Fiji, Gabon, Guinea Bissau, Latvia,
Malawi, Maldives, New Zealand, Pakistan, Serbia, Uzbekistan.
(First plenary meeting, 16 May 2011)
WHA64(2)
Election of officers of the Sixty-fourth World Health Assembly
The Sixty-fourth World Health Assembly elected the following officers:
President:
Dr Christos Patsalides (Cyprus)
Vice-Presidents:
Professor C.O. Onyebuchi Chukwu (Nigeria)
Mr Ri Jang Gon (Democratic People’s Republic of Korea)
Dr Enrique T. Ona (Philippines)
Dr Mohammad Hussein Nicknam (Islamic Republic of Iran)
Mrs Therese Baptiste-Cornelis (Trinidad and Tobago)
(First plenary meeting, 16 May 2011)
WHA64(3)
Election of officers of the main committees
The Sixty-fourth World Health Assembly elected the following officers of the main committees:
Committee A:
Chairman Dr Walid Ammar (Lebanon)
Committee B:
Chair man Dr Maria Teresa Valenzuela (Chile)
(First plenary meeting, 16 May 2011)
The main committees subsequently elected the following officers:
Committee A:
Committee B:
Vice-Chairmen
Dr Henry Madzorera (Zimbabwe)
Mr Nandi Glassie (Cook Islands)
Rapporteur
Dr Mast Kulzhanov (Kazakhstan)
Vice-Chairmen
Dr Ante-Zvonimir Golem (Croatia)
Mr Zangley Dukpa (Bhutan)
Rapporteur
Mr T. Tuitama Leao Tuitama (Samoa)
(First meetings of Committees A and B, 16 and 18 May 2011, respectively)
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60
WHA64(4)
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Establishment of the General Committee
The Sixty-fourth World Health Assembly elected the delegates of the following 17 countries as
members of the General Committee: Albania, Botswana, China, Cuba, Egypt, Eritrea, Ethiopia,
France, Gambia, Guinea, Hungary, India, Micronesia (Federated States of), Paraguay, Russian
Federation, United Kingdom of Great Britain and Northern Ireland, and United States of America.
(First plenary meeting, 16 May 2011)
WHA64(5)
Adoption of the agenda
The Sixty-fourth World Health Assembly adopted the provisional agenda prepared by the
Executive Board at its 128th session, with the deletion of four items and the transfer of five items from
Committee A to Committee B.
(Second plenary meeting, 16 May 2011)
WHA64(6)
Verification of credentials
The Sixty-fourth World Health Assembly recognized the validity of the credentials of the
following delegations: Afghanistan; Albania; Algeria; Andorra; Angola; Argentina; Armenia;
Australia; Austria; Azerbaijan; Bahamas; Bahrain; Bangladesh; Barbados; Belarus; Belgium; Benin;
Bhutan; Bolivia (Plurinational State of); Bosnia and Herzegovina; Botswana; Brazil; Brunei
Darussalam; Bulgaria; Burkina Faso; Burundi; Cambodia; Cameroon; Canada; Cape Verde; Central
African Republic; Chad; Chile; China; Colombia; Comoros; Congo; Cook Islands; Costa Rica; Côte
d’Ivoire; Croatia; Cuba; Cyprus; Czech Republic; Democratic People’s Republic of Korea;
Democratic Republic of the Congo; Denmark; Djibouti; Dominican Republic; Ecuador; El Salvador;
Equatorial Guinea; Eritrea; Estonia; Ethiopia; Fiji; Finland; France; Gabon; Gambia; Germany;
Ghana; Greece; Guatemala; Guinea; Guinea-Bissau; Guyana; Haiti; Honduras; Hungary; Iceland;
India; Indonesia; Iran (Islamic Republic of); Iraq; Ireland; Israel; Italy; Jamaica; Japan; Jordan;
Kazakhstan; Kenya; Kiribati; Kuwait; Kyrgyzstan; Lao People’s Democratic Republic; Latvia;
Lebanon; Lesotho; Liberia; Lithuania; Luxembourg; Madagascar; Malawi; Malaysia; Maldives; Mali;
Malta; Mauritania; Mauritius; Mexico; Micronesia (Federated States of); Monaco; Mongolia;
Montenegro; Morocco; Mozambique; Myanmar; Namibia; Nauru; Nepal; Netherlands; New Zealand;
Nicaragua; Niger; Nigeria; Norway; Oman; Pakistan; Palau; Panama; Papua New Guinea; Paraguay;
Peru; Philippines; Poland; Portugal; Qatar; Republic of Korea; Republic of Moldova; Romania;
Russian Federation; Rwanda; Saint Kitts and Nevis; Samoa; San Marino; Sao Tome and Principe;
Saudi Arabia; Senegal; Serbia; Sierra Leone; Singapore; Slovakia; Slovenia; Solomon Islands;
Somalia; South Africa; Spain; Sri Lanka; Sudan; Swaziland; Sweden; Switzerland; Syrian Arab
Republic; Thailand; Timor-Leste; Togo; Tonga; Trinidad and Tobago; Tunisia; Turkey; Turkmenistan;
Tuvalu; Uganda; Ukraine; United Arab Emirates; United Kingdom of Great Britain and Northern
Ireland; United Republic of Tanzania; United States of America; Uruguay; Uzbekistan; Vanuatu;
Venezuela (Bolivarian Republic of); Viet Nam; Yemen; Zambia; and Zimbabwe.
(Seventh plenary meeting, 18 May 2011)
RESOLUTIONS AND DECISIONS
WHA64(7)
61
Election of Members entitled to designate a person to serve on the
Executive Board
The Sixty-fourth World Health Assembly, after considering the recommendations of the
General Committee, elected the following as Members entitled to designate a person to serve on the
Executive Board: Cameroon, Mexico, Myanmar, Nigeria, Papua New Guinea, Qatar, Senegal, Sierra
Leone, Switzerland, Uzbekistan.
(Ninth plenary meeting, 20 May 2011)
WHA64(8)
United Nations Joint Staff Pension Fund: appointment
representatives to the WHO Staff Pension Committee
of
The Sixty-fourth World Health Assembly nominated Dr Ebenezer Appiah-Denkyira of the
delegation of Ghana as a member, and Mrs Palanitina Tupuimatagi Toelupe of the delegation of
Samoa as an alternate member, of the WHO Staff Pension Committee for a three-year term until
May 2014 as well as Dr Viroj Tangcharoensathien of the delegation of Thailand as a member of the
WHO Staff Pension Committee for the remainder of the term of office of Dr A.A. Yoosuf of the
delegation of Maldives, namely, until May 2013.
(Tenth plenary meeting, 24 May 2011)
WHA64(9)
Selection of the country in which the Sixty-fifth World Health Assembly
would be held
The Sixty-fourth World Health Assembly, in accordance with Article 14 of the Constitution,
decided that the Sixty-fifth World Health Assembly would be held in Switzerland.
(Tenth plenary meeting, 24 May 2011)
WHA64(10)
Substandard/spurious/falsely-labelled/falsified/counterfeit medical products
The Health Assembly considered the report of the Working Group of Member States
on Substandard/Spurious/Falsely-Labelled/Falsified/Counterfeit Medical Products contained in
document A64/16 and decided to accept the “Next steps” contained in the report. The Health
Assembly specifically decided to extend the period set out in decision WHA63(10) in order to allow
the Working Group to complete its work as soon as possible.
It was further decided that the Working Group should resume its work as soon as possible
following the Sixty-fourth World Health Assembly and report on its work to the Sixty-fifth World
Health Assembly through the Executive Board at its 130th session.
(Tenth plenary meeting, 24 May 2011)
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
WHA64(11)
Smallpox eradication: destruction of variola virus stocks1
The World Health Assembly decided to reaffirm strongly the decisions of previous Health
Assemblies that the remaining stocks of variola virus should be destroyed.
The Health Assembly also reaffirmed the need to reach consensus on a proposed new date for
the destruction for the variola virus stocks, when research outcomes crucial to an improved public
health response to an outbreak so permit.
It also decided to include a substantive item “Smallpox eradication: destruction of variola virus
stocks” on the provisional agenda of the Sixty-seventh World Health Assembly, through the Executive
Board, following the Sixty-sixth World Health Assembly.
(Tenth plenary meeting, 24 May 2011)
_______________
1
See Annex 6 for the financial and administrative implications for the Secretariat of this decision.
ANNEXES
ANNEX 11
Recommendations contained in the final report of the Review Committee
on the Functioning of the International Health Regulations (2005)
in relation to Pandemic (H1N1) 2009
[A64/10 – 5 May 2011]
Recommendation 1
Accelerate implementation of core capacities required by the International Health Regulations
(2005). WHO and States Parties should refine and update their strategies for implementing the
capacity-building requirements of the International Health Regulations (2005) (IHR), focusing first on
those countries that will have difficulty meeting the 2012 deadline for core capacities. One possible
way to support and accelerate implementation would be for WHO to mobilize appropriate agencies
and organizations that would be willing to provide technical assistance to help interested countries
assess their needs and make the business case for investment. Making the case for investment in IHR
capacity building and subsequent resource mobilization would increase the likelihood that more States
Parties could come into compliance with the IHR. Donor countries and organizations could take
advantage of the IHR Annex 1A as a priority list for development support and also seize opportunities
to share specialized resources, such as laboratories, across countries. WHO should also update the
2007 guidance on National Focal Point functions, and include examples of good practice to reinforce
the value of the IHR.
Recommendation 2
Enhance the WHO Event Information Site. WHO should enhance its Event Information Site (EIS)
to make it an authoritative resource for disseminating reliable, up-to-date and readily accessible
international epidemic information. States Parties should be able to rely on the EIS as a primary source
for information on epidemiological status, risk assessment, response measures and their rationales.
The EIS could also be used to post WHO guidance before it is made public. Additional ways to
enhance the EIS include:
• Using EIS for guidance and messages to NFPs.
• States Parties allowing WHO to share more information.
• Including more events and expanding information on each event. For instance, for each event
there could be maps, expanded risk assessments and recommendations, and links to relevant
WHO guidance and Collaborating Centres.
• Posting all temporary and standing recommendations issued under the IHR as well as
information on Member States that institute additional measures and their rationales for these,
and the status of WHO’s request for such a rationale.
1
See resolution WHA64.1.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Recommendation 3
Reinforce evidence-based decisions on international travel and trade. When States Parties
implement health measures that significantly interfere with international traffic and are more stringent
than those recommended by WHO, IHR Article 43 provides that the States Parties shall inform WHO
of their actions. (As stated in Article 43, “significant interference generally means refusal of entry or
departure of international travellers, baggage, cargo, containers, conveyances, goods and the like, or
their delay, for more than 24 hours.”) In such circumstances, WHO should energetically seek to obtain
the public-health rationale and relevant scientific information, share it with other States Parties, and,
where appropriate, request reconsideration, as stipulated under Article 43. WHO should review and
assess the effectiveness and impact of border measures taken during the pandemic to support
evidence-based guidance for future events.
Recommendation 4
Ensure necessary authority and resources for all National IHR Focal Points. States Parties should
ensure that designated National IHR Focal Points have the authority, resources, procedures,
knowledge and training to communicate with all levels of their governments and on behalf of their
governments as necessary.
Recommendation 5
Strengthen WHO’s internal capacity for sustained response. WHO should strengthen its internal
capacity to respond to a sustained Public Health Emergency of International Concern, such as a
pandemic, identifying the skills, resources and internal arrangements to support a response that
extends beyond a few months. Among the internal arrangements that WHO should reinforce are:
• Identify the skills, resources and adjustments needed for WHO to carry out its role in
coordination and global support.
• Establish an internal, trained, multidisciplinary group of staff who will be automatically
released from their normal duties for an unspecified duration, with a relief rotation after a
designated interval.
• Ensure a 24/7 capacity to meet the personal needs for accommodation, meals, transportation
and childcare of WHO staff enlisted in a sustained emergency response.
• Establish an event management structure that could be maintained throughout a future
pandemic or other sustained global public-health emergency.
Recommendation 6
Improve practices for appointment of an Emergency Committee. WHO should adopt policies,
standards and procedures for the appointment and management of an Emergency Committee (EC),
which assure an appropriate spectrum of expertise on the committee, inclusive consultation and
transparency with respect to freedom from conflicts of interest.
• As provided in Article 48 of the IHR, WHO should appoint an Emergency Committee with
the spectrum of expertise and geographical representation appropriate for each event. The
Review Committee also concluded that a broader spectrum of expertise among EC members
might have been useful, including in risk communication. The Review Committee
ANNEX 1
67
acknowledged that WHO must appoint an EC with a set of skills and expertise that is
appropriate for and particular to each event for which it is constituted. For an influenza
pandemic, this expertise would include virology, laboratory assessment, epidemiology,
public-health field and leadership experience, veterinary science, risk assessment and risk
communication and methodological expertise in systematic reviews of the scientific literature.
• To ensure that the full range of views is presented, WHO should invite all members of an
Emergency Committee to participate in all of its major deliberations.
• WHO should clarify its standards and adopt more transparent procedures for the appointment
of members of expert committees, such as an Emergency Committee, with respect to potential
conflicts of interest. The identity and relevant background, experience and relationships of
Emergency Committee members should be publicly disclosed at the time of their proposed
appointment, with an opportunity for public comment during a period of initial, probationary
service that would apply to all members. WHO should have clear standards for determining
when a conflict of interest exists that warrants disqualifying an individual, and have clear
procedures to determine when and on what basis exceptions may be made to obtain necessary
expertise or balance. The Review Committee appreciates the need for expert consultations to
be held in confidence so that the Director-General will have the benefit of candid discussion
and advice. The desirability of confidential consultation heightens the burden of transparency
on standards for appointment.
• As part of a more proactive and rigorous approach to managing conflicts of interest, WHO
should appoint a designated ethics officer.
Recommendation 7
Revise pandemic preparedness guidance. WHO should revise its pandemic preparedness guidance
in order to: simplify the phase structure (one possible paradigm would include only three phases –
baseline, alert phase, pandemic); emphasize a risk-based approach to enable a more flexible response
to different scenarios; rely on multisectoral participation; draw upon lessons learnt at a country,
regional and global level; and include further guidance on risk assessment.
Recommendation 8
Develop and apply measures to assess severity. WHO should develop and apply measures that can
be used to assess the severity of every influenza epidemic. By applying, evaluating and refining tools
to measure severity every year, WHO and Member States can be better prepared to assess severity in
the next pandemic. Assessing severity does not require altering the definition of a pandemic to depend
on anything other than the degree of spread. Rather, while not part of the definition of a pandemic,
measured and projected severity are key components of decision-making in the face of a pandemic.
The Committee recognizes that estimating severity is especially difficult in the early phase of an
outbreak, that severity typically varies by place and over time, and that severity has multiple
dimensions (deaths, hospitalizations and illness, with each varying by age and other attributes, such as
pre-existing health conditions and access to care; burden on a health system and social and economic
factors). Descriptive terms used to characterize severity, such as mild, moderate and severe, should be
quantitatively defined in future WHO guidelines so that they may be used consistently by different
observers and in different settings. The Committee urges consideration of adaptive measures that
would move as rapidly as possible from early counts of cases, hospitalizations and deaths to
population-based rates. Severity should be assessed as early as possible during a pandemic and
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
continually re-assessed as the pandemic evolves and new information becomes available. Severity
might be assessed using a “basket of indicators” in a pre-agreed minimum data set (e.g. hospitalization
rates, mortality data, identification of vulnerable populations and an assessment of the impact on
health systems). Estimates of severity should be accompanied by expressions of confidence or
uncertainty around the estimates.
Recommendation 9
Streamline management of guidance documents. WHO needs a strategy and document management
system to cope with the development, clearance, translation and dissemination of guidance and other
technical documents in a timely and consistent way during a public-health emergency. Interim
guidance should be revised as data become available. When feasible, if the guidelines have potential
policy implications, WHO should make every effort to consult with Member States and provide them
with advance notice of impending publications. WHO should develop the capacity to assure
consistency of guidelines across the Organization, recognizing that conditions in different regions and
individual countries may vary.
Recommendation 10
Develop and implement a strategic, organization-wide communications policy. WHO should
develop an organization-wide communications policy and a strategic approach to improve routine and
emergency communications. A strategic approach entails matching the content, form and style of
communication with the media, timing and frequency that will reach the intended audience and serve
the intended purpose. WHO should be prepared to sustain active, long-term communications outreach
when circumstances require, to acknowledge mistakes and to respond professionally and vigorously to
unwarranted criticisms. Web publishing procedures should be clarified so that changes in web pages
can be historically tracked and archived. WHO should invest in a robust social media presence for
rapid communication to a wider, more diverse audience.
Recommendation 11
Encourage advance agreements for vaccine distribution and delivery. In concert with efforts by
Member States, and building on existing vaccine distribution systems, WHO should encourage
advance agreements with and among appropriate agencies and authorities in Member States, vaccine
manufacturers and other relevant parties that would facilitate approval and delivery of pandemic
vaccines to low-resource countries, to increase equity in supply and support advance planning for
administration of vaccines.
Recommendation 12
Establish a more extensive global, public-health reserve workforce. Member States, in concert
with WHO, should establish a more extensive global reserve workforce of experts and public-health
professionals to be mobilized as part of a sustained response to a global health emergency and
deployed for service in countries that request such assistance. The size, composition and governing
rules for activating and deploying such an entity – the Global Health Emergency Workforce – should
be developed through consultation and mutual agreement among the Member States and WHO. The
number and particular skills of the experts deployed will depend on specific characteristics of the
emergency to which the workforce is responding. This workforce would significantly expand the
current Global Outbreak and Alert Response Network by strengthening its composition, resources and
capacity, with a view towards better support for sustained responses to public-health emergencies.
ANNEX 1
69
At present, WHO’s capacity to prepare and respond in a sustained way to any public-health emergency
is severely limited by chronic funding shortfalls, compounded by restrictions on the use of funds from
Member States, partners and other donors. Mindful of concerns about efficiency and accountability
that motivate some of the restrictions, the Committee concludes that the establishment of a
contingency fund outside of WHO, but available for deployment by WHO at the time of a publichealth emergency, will be a prudent step to assure an immediate and effective global response.
Recommendation 13
Create a contingency fund for public-health emergencies. Member States should establish a publichealth emergency fund of at least US$ 100 million, to be held in trust in a location and form that
would be readily accessible to WHO. The fund, which would support surge capacity, not the purchase
of materials, would be released in part or whole during a declared Public Health Emergency of
International Concern, based on approval of a plan for expenditures and accountability submitted by
WHO. The precise conditions for use of the fund should be negotiated among the Member States in
consultation with WHO.
The Review Committee commends the effort made by Member States to reach agreement on sharing
of viruses and access to vaccines and other benefits. The Review Committee believes that success will
depend on a mutual expectation of proportionate, balanced benefit and contribution by all
stakeholders. An agreement that is one-sided or that expects contribution without benefit, or vice
versa, will be neither acceptable nor sustainable. The Review Committee also believes that obligations
and benefits not linked to a legal framework are unlikely to last.
Recommendation 14
Reach agreement on sharing of viruses and access to vaccines and other benefits. The Review
Committee urges Member States and WHO to conclude negotiations under the Open-ended Working
Group of Member States on Pandemic Influenza Preparedness: Sharing of Influenza Viruses and
Access to Vaccines and Other Benefits. A successful conclusion to this negotiation will lead to wider
availability of vaccines and other benefits and greater equity in the face of the next pandemic, as well
as continued timely sharing of influenza viruses.
The Review Committee offers the following elements for consideration as part of an acceptable
agreement.
Measures to expand global influenza vaccine production capacity:
• WHO should continue its practice of working with public-health laboratories to make seed
vaccine virus strains widely available to all vaccine manufacturers.
• In so far as it is consistent with national priorities, risk assessments and resources, the Review
Committee urges countries to immunize their high-risk populations yearly against seasonal
influenza. This can reduce the burden of disease. In addition, this can increase experience
with local production, distribution and delivery and encourage more global capacity for
vaccine production. More generally, experience with comprehensive programmes during
seasonal influenza (in such areas as surveillance, communication, professional and public
education, health-protection measures and pharmaceuticals) provides valuable preparation in
advance of a major pandemic.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
• The Committee urges countries to strengthen their capacity to receive, store, distribute and
administer vaccines. Technological advances that reduce reliance on a cold chain and
otherwise simplify administration will streamline these processes.
• The Committee urges Member States, international organizations and industry to aid the
transfer of technologies for vaccine and adjuvant production in parts of the world currently
lacking this capacity, such as Africa, through established programmes such as the Global
Action Plan to Increase Supply of Pandemic Influenza Vaccines (GAP).
Measures to increase access, affordability and deployment of pandemic vaccine:
• All vaccine manufacturers should commit to a contribution of 10% of pandemic influenza
vaccine from each production run to a global redistribution pool. WHO should be responsible
for managing allocations from this pool based on advice from a consultative committee.
• Increased access to vaccines and antiviral drugs can be achieved through advance agreements
between industry, WHO and countries. These agreements should be negotiated without regard
to virus subtype, for a specified period of time (e.g. three to five years) and should be
regularly reviewed and renewed.
• Other measures that may promote greater and more equitable access to vaccine include
differential pricing, direct economic aid to low-resource countries and additional donations of
vaccine from purchasing countries or manufacturers.
• Countries that receive donated vaccine, as any purchaser of the vaccine, should adhere to the
same practices of releasing and indemnifying manufacturers from certain legal liabilities.
Measures to detect and promptly identify potential pandemic influenza viruses:
• Every Member State should commit to share promptly, according to the principles of sharing
of influenza viruses and access to vaccines and other benefits, any biological specimens and
viral isolates that may be related to a new or emerging influenza virus in humans with WHO
collaborating laboratories. Viruses isolated from animals should be promptly sent through the
appropriate animal health system. The sharing of specimens and viral isolates should be
accompanied by arrangements to share benefits, including access to vaccines.
The world’s capacity to prevent and limit a severe pandemic is constrained by many factors:
predominant reliance on vaccine production technology that has changed little in 60 years; the need to
match vaccine to particular viral strains; the inability to predict which influenza viruses will be
dangerous to human health; uncertainty about the effectiveness of many pharmaceutical and publichealth measures; the lack of field-based, rapid, affordable, highly sensitive and specific diagnostic
tests; and limitations of infrastructure, resources and capacities in many countries. Also needed are
improved knowledge of and practical strategies for implementing public-health and personalprotective measures, such as handwashing, respiratory etiquette, isolation and social distancing.
Some of these limitations can be reduced over time through national and international research.
Further, the results of research on personal and public-health protective measures may apply to any
emerging public-health threat, especially when few or no drugs or vaccines exist. Because assessment
of public-health measures typically must occur in real time in the midst of an outbreak, it is crucial to
design and prepare research protocols and plans in advance. Beyond research advances, global
resilience depends on host and environmental factors, so that improving health status, promoting
ANNEX 1
71
economic development and strengthening health systems can mitigate the impact of a future pandemic
virus.
Recommendation 15
Pursue a comprehensive influenza research and evaluation programme. Member States,
individually and in cooperation with one another, and WHO should pursue a comprehensive influenza
research and evaluation programme. This should build on a thorough review of the evidence gained in
all fields from the 2009 H1N1 pandemic. Key research goals include: strengthen surveillance
technology and epidemiological and laboratory capacity to improve detection, characterization and
monitoring of new viruses; identify viral and host determinants of transmissibility and virulence;
develop rapid, accurate, inexpensive point-of-care diagnostic tests; enhance the accuracy and
timeliness of modelling projections; create broader spectrum, highly effective, safe and longer-lasting
vaccines; hasten vaccine production and increase throughput; devise more effective antiviral drugs and
antimicrobials to treat bacterial complications; evaluate the effectiveness of drug, vaccine, personal
protective equipment, personal hygiene and social interventions; assess the effectiveness and costs of
border measures and enhance risk communication. Much of this research and evaluation can and
should be carried out in the absence of a pandemic. However some studies can only be carried out
during a global event such as a pandemic. For these it is essential that protocols be prepared and
funding identified in advance so that research can begin without delay.
Table Lead responsibility and time frame to complete implementation of recommendations
WHO led
Short term
(within 1 year)
Medium term
(within 2 years)
Long term
(beyond 2 years)
Enhance the WHO Event
Information Site
(Recommendation 2)
Revise pandemic
preparedness guidance
(Recommendation 7)
Reinforce evidencebased decisions on
international travel
and trade
(Recommendation 3)
Strengthen WHO’s internal
capacity for sustained
response
(Recommendation 5)
Develop and apply
measures to assess
severity
(Recommendation 8)
Improve practices for
appointment of an
Emergency Committee
(Recommendation 6)
Streamline management of
guidance documents
(Recommendation 9)
Develop and implement a
strategic, organization-wide
communications policy
(Recommendation 10)
Country led
Reach agreement on the
sharing of viruses and
access to vaccines and other
benefits
(Recommendation 14)
Ensure necessary
authority and
resources for all
National IHR Focal
Points
(Recommendation 4)
Accelerate
implementation of core
capacities required by
the IHR
(Recommendation 1)
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Short term
(within 1 year)
Jointly led
Medium term
(within 2 years)
Long term
(beyond 2 years)
Encourage advance
agreements for vaccine
distribution and
delivery
(Recommendation 11)
Pursue a
comprehensive
influenza research and
evaluation programme
(Recommendation 15)
Establish a more
extensive global,
public-health reserve
workforce
(Recommendation 12)
Create a contingency
fund for public-health
emergencies
(Recommendation 13)
_______________
ANNEX 2
Pandemic Influenza Preparedness Framework for the sharing of
influenza viruses and access to vaccines and other benefits
[A64/9, Attachment 2 – 5 May 2011]
1.
PRINCIPLES ........................................................................................................................
81
2.
OBJECTIVE .........................................................................................................................
82
3.
SCOPE ..................................................................................................................................
82
4.
DEFINITIONS AND USE OF TERMS ...............................................................................
83
4.1
5.
6.
Pandemic influenza preparedness biological materials or PIP biological
materials……………………………………………………………... .......................
83
4.2
Other technical terms …………………………………….. .......................................
83
4.3
Institutions, organizations and entities .......................................................................
84
4.4
Other terms .................................................................................................................
85
PANDEMIC INFLUENZA PREPAREDNESS SYSTEM FOR SHARING OF H5N1
AND OTHER INFLUENZA VIRUSES WITH HUMAN PANDEMIC POTENTIAL ......
86
5.1
General........................................................................................................................
86
5.2
Genetic sequence data.................................................................................................
86
5.3
Traceability and reporting mechanisms ......................................................................
87
5.4
Standard Material Transfer Agreements .....................................................................
87
PANDEMIC INFLUENZA PREPAREDNESS BENEFIT SHARING SYSTEM ..............
87
6.0
General........................................................................................................................
87
6.1
WHO coordination of pandemic influenza preparedness and response .....................
88
6.2
Pandemic risk assessment and risk response ..............................................................
88
6.3
Provision of PIP candidate vaccine viruses ................................................................
88
6.4
Provision of diagnostic reagents and test kits .............................................................
89
6.5
Provision of reference reagents for potency determination of vaccines .....................
89
6.6
Laboratory and influenza surveillance capacity building ...........................................
89
6.7
Regulatory capacity building ......................................................................................
89
6.8
Antivirals stockpiles ...................................................................................................
90
6.9
Pandemic influenza preparedness vaccine stockpile ..................................................
90
6.10 Access to vaccines in the inter-pandemic period for developing countries ................
91
6.11 Access to pandemic influenza vaccines ......................................................................
91
- 73 -
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6.12 Tiered pricing ..............................................................................................................
91
6.13 Technology transfer ....................................................................................................
91
6.14 Sustainable and innovative financing mechanisms .....................................................
92
GOVERNANCE AND REVIEW .........................................................................................
93
7.1
General ........................................................................................................................
93
7.2
Advisory Group ..........................................................................................................
94
7.3
Governance and review of terms of reference for WHO global influenza
surveillance and response system (GISRS) laboratories .............................................
94
Monitoring and review of the Pandemic Influenza Preparedness Framework ...........
95
APPENDIX 1 Standard Material Transfer Agreement 1 ..............................................................
96
APPENDIX 2 Standard Material Transfer Agreement 2 ..............................................................
100
APPENDIX 3 Advisory Group terms of reference .......................................................................
104
APPENDIX 4 Guiding Principles for the development of terms of reference for current and
potential future WHO global influenza surveillance and response system
(GISRS) laboratories for H5N1 and other human pandemic influenza viruses .....
107
APPENDIX 5 Terms of reference related to work with pandemic influenza preparedness
biological materials ................................................................................................
109
7.
7.4
ANNEX 2
75
1. PRINCIPLES
In relation to pandemic influenza preparedness: sharing of influenza viruses and access to vaccines
and other benefits, WHO Member States:
(1) recall World Health Assembly resolution WHA60.28 on pandemic influenza preparedness:
sharing of influenza viruses and access to vaccines and other benefits;
(2) note the continuing risk of an influenza pandemic with potentially devastating health, economic
and social impacts, particularly for developing countries, which suffer a higher disease burden and are
more vulnerable;
(3) recognize that Member States have a commitment to share on an equal footing H5N1 and other
influenza viruses of human pandemic potential and the benefits, considering these as equally important
parts of the collective action for global public health;
(4) this Framework will be guided by the goal of its universal application for the protection of all
people of the world from the international spread of disease;
(5) recall the need for rapid, systematic and timely sharing of H5N1 and other influenza viruses
with human pandemic potential with WHO Collaborating Centres on Influenza and WHO H5
Reference Laboratories as a contribution to assessment of pandemic risk, development of pandemic
vaccines, updating of diagnostic reagents and test kits, and surveillance for resistance to antiviral
medicines;
(6)
reaffirm obligations of States Parties under the International Health Regulations (2005);
(7) recognize this Framework is to be implemented in a manner consistent with applicable national
and international laws, regulations, and obligations;
(8) recognize that the benefits arising from the sharing of H5N1 and other influenza viruses with
human pandemic potential should be shared with all Member States based on public health risk and
need;
(9) recognize the need for a fair, transparent, equitable and efficient framework for the sharing of
H5N1 and other influenza viruses with human pandemic potential and for the sharing of benefits,
including access to and distribution of affordable diagnostics and treatments, including vaccines, to
those in need, especially in developing countries, in a timely manner;
(10) recognize also the WHO leadership and oversight functions over these issues and the need for
collaboration with the United Nations System Influenza Coordinator and with relevant
intergovernmental organizations;
(11) recognize the sovereign right of States over their biological resources and the importance of
collective action to mitigate public health risks;
(12) recall the global strategy on public health, innovation and intellectual property, adopted in
resolution WHA61.21;
(13) recall that resolutions WHA60.28 and WHA61.21 recognize that “intellectual property rights do
not and should not prevent Member States from taking measures to protect public health” and “that
intellectual property rights are an important incentive in the development of new health care products.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
However, this incentive alone does not meet the need for the development of new products to fight
diseases where the potential paying market is small or uncertain”;
(14) recognize that the commitment to share on an equal footing H5N1 and other influenza viruses of
human pandemic potential and the benefits enables WHO Member States and the Director-General to
assess the global risk of an influenza pandemic and allows WHO Member States and the
Director-General to take actions to reduce the risk of the emergence of a pandemic and to facilitate the
development and production of vaccines, diagnostic materials and other pharmaceuticals that can
assist in rapidly responding to and containing an emerging pandemic;
(15) acknowledge with serious concern that current global influenza vaccine production capacity
remains insufficient to meet anticipated need in a pandemic;
(16) acknowledge with serious concern that the distribution of influenza vaccine manufacturing
facilities is inadequate particularly in developing countries and that some Member States can neither
develop, produce, afford nor access the vaccines and other benefits;
(17) note the WHO Global pandemic influenza action plan to increase vaccine supply (GAP)1 and its
goal of reducing the gap between potential vaccine demand and supply during an influenza pandemic,
by expanding the global capacity to produce influenza vaccine, including in developing countries;
(18) recognize the importance of Member States, pharmaceutical manufacturers and other entities
with access to relevant technologies in respect of influenza vaccine, diagnostics, and pharmaceuticals
making specific efforts to transfer these technologies, skills, knowledge and know-how to countries,
particularly developing countries, that do not currently have access to these technologies, skills,
knowledge and know-how;
(19) recognize the need for financing mechanisms that would promote affordability and equitable
access to quality influenza vaccines, medicines and technologies by developing countries.
2. OBJECTIVE
The objective of the Pandemic Influenza Preparedness Framework is to improve pandemic influenza
preparedness and response, and strengthen the protection against the pandemic influenza by improving
and strengthening the WHO global influenza surveillance and response system (“WHO GISRS”), with
the objective of a fair, transparent, equitable, efficient, effective system for, on an equal footing:
(i)
the sharing of H5N1 and other influenza viruses with human pandemic potential; and
(ii)
access to vaccines and sharing of other benefits.
3. SCOPE
3.1 This Framework applies to the sharing of H5N1 and other influenza viruses with human
pandemic potential and the sharing of benefits.
3.2 This Framework does not apply to seasonal influenza viruses or other non-influenza pathogens
or biological substances that may be contained in clinical specimens shared under this Framework.
1
Document WHO/CDS/EPR/GIP/2006.1.
ANNEX 2
77
4. DEFINITIONS AND USE OF TERMS
For the purpose of this Framework, the following terms have the meanings assigned to them below.
4.1
Pandemic influenza preparedness biological materials or PIP biological materials
“PIP biological materials”,1 for the purposes of this Framework (and its appended Standard Material
Transfer Agreements (SMTAs) and terms of reference (TORs)) and the Influenza Virus Tracking
Mechanism (IVTM), includes human clinical specimens,2 virus isolates of wild type human H5N1 and
other influenza viruses with human pandemic potential; and modified viruses prepared from H5N1
and/or other influenza viruses with human pandemic potential developed by WHO GISRS
laboratories, these being candidate vaccine viruses generated by reverse genetics and/or high growth
re-assortment.
Also included in “PIP biological materials” are RNA extracted from wild-type H5N1 and other human
influenza viruses with human pandemic potential and cDNA that encompass the entire coding region
of one or more viral genes.1
4.2
Other technical terms
“Genetic sequences” means the order of nucleotides found in a molecule of DNA or RNA. They
contain the genetic information that determines the biological characteristics of an organism or a virus.
“Reference reagents” are biological or chemical substances or organisms and parts thereof used in
diagnostic or surveillance activities. They are rigorously characterized and shown to be suitable for
use as standards in order to compare and validate results of analyses obtained in different laboratories.
“Reference reagents for potency determination of vaccines/vaccine potency reagents” means reagents
used by vaccine manufacturers and regulatory laboratories for the purpose of testing and standardizing
the potency of vaccines against H5N1 and other influenza viruses with human pandemic potential.
“Influenza virus with human pandemic potential” designates any wild-type influenza virus that has
been found to infect humans and that has a haemagglutinin antigen that is distinct from those in
seasonal influenza viruses so as to indicate that the virus has potential to be associated with pandemic
spread within human populations with reference to the International Health Regulations (2005) for
defining characteristics.
“Pandemic influenza preparedness vaccine virus” or “PIP vaccine virus” connotes any high-growth
reassortant virus or any influenza reference virus, WHO-recommended influenza virus for vaccine use
or other influenza virus material generated, including by new and emerging technologies, from H5N1
or other influenza virus with human pandemic potential that is provided to influenza vaccine
manufacturers for the purposes of developing a prototype pandemic, pre-pandemic, pandemic or other
influenza vaccine.
1
OPERATIONAL EXEMPTION: materials shared within the WHO GISRS or with other laboratories specifically for
non-commercial public health uses including surveillance activities, diagnostic applications, and quality assurance, are not
handled as PIP Biological Materials. Their onward transfer for purposes other than those specified in the terms of reference
of National Influenza Centres, WHO Collaborating Centres, Essential Regulatory Laboratories and H5 Reference
Laboratories is not allowed under this operational exemption.
2
The definition for this term has been provided.
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“Clinical specimens” means materials taken from humans or animals, in as far as the samples taken
from animals are shared by originating countries/laboratories with the WHO GISRS. These include
specimens collected from the respiratory tract (for example, swabs and aspirated fluid), and also
blood, serum, plasma, faeces, and tissues, for diagnostic purposes, detection of pathogens and further
characterization, study or analysis.
“High-growth reassortant influenza viruses” means hybrid influenza viruses, including recombinant
viruses, that have been generated from two or more different influenza viruses and selected to grow
better in eggs or tissue cultures for optimal influenza vaccine production.
“Influenza reference viruses” means wild-type influenza viruses of human or animal origin that WHO
has selected as representative of important groups of influenza viruses on the basis of extensive
antigenic and genetic studies and comparisons with influenza viruses from many countries. As the
influenza viruses evolve in nature, new influenza reference viruses are selected.
“WHO-recommended influenza viruses for vaccine use” means wild-type influenza viruses that are
recommended by WHO as the basis for an influenza vaccine.
“Wild-type influenza viruses or influenza virus isolates” means naturally occurring influenza viruses
that have been detected by any means including molecular methodology and/or cultured either in eggs
or cells (i.e. isolated) directly from clinical specimens or subsequent culture passages and have not
been purposefully modified.
4.3
Institutions, organizations and entities
“Essential regulatory laboratories” means influenza laboratories designated by WHO located in, or
associated with, national regulatory agencies and which have a critical role at the global level for
developing, regulating and standardizing human influenza vaccines. Such laboratories participate in
the WHO GISRS in accordance with their corresponding terms of reference.
“Influenza vaccine, diagnostic and pharmaceutical manufacturers” means public or private entities
including academic institutions, government owned or government subsidized entities, nonprofit
organizations or commercial entities that develop and/or produce human influenza vaccines and other
products derived from or using H5N1 or other influenza viruses of human pandemic potential.
“National Influenza Centres” or “NICs” means influenza laboratories authorized and designated by the
Member State and subsequently recognized by WHO to perform a number of functions including
providing PIP biological materials to the WHO GISRS in accordance with the terms of reference.
“Other authorized laboratory” means influenza laboratories authorized by the Member State to provide
PIP biological materials to the WHO GISRS. This term is intended to cover laboratories in those
Member States which do not have a National Influenza Centre or Member States with NICs but which
also have additional laboratories with certain roles usually performed by NICs.
“Public health researchers” means researchers in public health and/or basic sciences at public or
private institutions outside of the WHO GISRS, universities and other academic research institutions
with a primary research interest in public health.
“WHO Collaborating Centres on Influenza” or “WHO CCs” means influenza laboratories designated
by WHO and supported by national authorities to perform certain roles within the WHO GISRS, and
which have accepted formal terms of reference from WHO. In general, they differ from National
Influenza Centres and WHO H5 Reference Laboratories in having global responsibilities and more
extensive technical capacities.
ANNEX 2
79
“WHO H5 Reference Laboratories” means influenza laboratories that have been designated by WHO
in order to strengthen national and regional capacity for reliably diagnosing H5 virus infection until
this capacity is more widespread.
“WHO GISRS” means the international network of influenza laboratories, coordinated by WHO, that
conduct year-round surveillance of influenza, assessing the risk of pandemic influenza and assisting in
preparedness measures. The WHO GISRS comprises National Influenza Centres, WHO Collaborating
Centres on Influenza, WHO H5 Reference Laboratories and Essential Regulatory Laboratories.
4.4
Other terms
“Advisory Group” means the Group referred to in section 7.2 of this Framework.
“Affected country” means countries with laboratory confirmed cases of H5N1, or other influenza
viruses with human pandemic potential.
“Director-General” means the Director-General of the World Health Organization.
“Least-developed country” means those countries that are periodically classified as least-developed
countries by the United Nations Committee for Development Policy.
“Originating laboratory” means a National Influenza Centre or other authorized laboratory that
initially sends PIP biological materials/clinical specimens to other laboratories within the WHO
GISRS and to other recipients.
“Originating Member State” means the Member State where the PIP biological materials/clinical
specimens were first collected.
“Pandemic Influenza Preparedness Framework” means this Pandemic Influenza Preparedness
Framework for the sharing of influenza viruses and access to vaccines and other benefits.
“Influenza Virus Traceability Mechanism” (“IVTM”) means an IT-based system for tracking the
transfer and movement of PIP biological materials into, within and out of the WHO GISRS as defined
in the Framework.
“WHO antivirals stockpile” means a reserved quantity of antiviral medicines and associated
equipment for management of outbreaks of H5N1 and other influenza viruses with human pandemic
potential, as specified in section 6.8 of this Framework.
“WHO Member States” means the States party to the WHO Constitution.
“WHO pandemic influenza preparedness vaccine stockpile” or “PIP vaccine stockpile” is the stockpile
of vaccines for H5N1 or other influenza viruses with human pandemic potential referred to in section
6.9 of this Framework.
“WHO Secretariat” has the meaning assigned to it in the WHO Constitution.
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5. PANDEMIC INFLUENZA PREPAREDNESS SYSTEM FOR SHARING OF H5N1
AND OTHER INFLUENZA VIRUSES WITH HUMAN PANDEMIC POTENTIAL
5.1
General
5.1.1 Member States, through their National Influenza Centres and Other authorized laboratories,
should in a rapid, systematic and timely manner provide PIP biological materials from all cases of
H5N1 and other influenza viruses with human pandemic potential, as feasible, to the WHO
Collaborating Centre on Influenza or WHO H5 Reference Laboratory of the originating Member
State’s choice.
5.1.2 By providing PIP biological materials from National Influenza Centres and Other authorized
laboratories to WHO Collaborating Centres on Influenza and WHO H5 Reference Laboratories as set
out in section 5.1.1 above, Member States provide their consent for the onward transfer and use of PIP
biological materials to institutions, organizations and entities, subject to provisions in the Standard
Material Transfer Agreements.
5.1.3 National Influenza Centres and Other authorized laboratories will make, as feasible, efforts to
ensure that PIP biological materials, from cases of H5N1 and other influenza viruses with human
pandemic potential, that they provide to WHO Collaborating Centres on Influenza and WHO H5
Reference Laboratories:
(i)
contain viable material; and
(ii) are accompanied by information as agreed in the Influenza Virus Traceability Mechanism
and other clinical and epidemiological information needed for risk assessment.
5.1.4 Member States may also provide PIP biological materials directly to any other party or body on
a bilateral basis provided that the same materials are provided on a priority basis to the WHO
Collaborating Centres on Influenza and/or H5 Reference Laboratories under this Framework.
5.2
Genetic sequence data
5.2.1 Genetic sequence data, and analyses arising from that data, relating to H5N1 and other influenza
viruses with human pandemic potential should be shared in a rapid, timely and systematic manner with
the originating laboratory and among WHO GISRS laboratories.
5.2.2 Recognizing that greater transparency and access concerning influenza virus genetic sequence
data is important to public health and there is a movement towards the use of public-domain or publicaccess databases such as Genbank and GISAID respectively; and
5.2.3 Recognizing that in some instances the publication of genetic sequence data has been
considered sensitive by the country providing the virus;
5.2.4 Member States request the Director-General to consult the Advisory Group on the best process
for further discussion and resolution of issues relating to the handling of genetic sequence data from
H5N1 and other influenza viruses with pandemic potential as part of the Pandemic Influenza
Preparedness Framework.
ANNEX 2
5.3
81
Traceability and reporting mechanisms
5.3.1 The Director-General, in consultation with the Advisory Group,1 will put in place in a timely
manner a transparent traceability mechanism that uses an electronic system in order to track in real
time the movement of PIP biological materials into, within, and out of the WHO GISRS.
5.3.2 To ensure that rapid, systematic and timely feedback is provided to Originating laboratories and
Member States, the Director-General will also include in the traceability mechanism and associated
electronic reporting systems a request that WHO Collaborating Centres, H5 Reference Laboratories
and Essential Regulatory Laboratories provide a summary report of laboratory analyses and on request
any other available information required by the originating laboratory regarding PIP biological
materials.
5.3.3 In order to ensure that the IVTM does not hinder the functioning of the WHO GISRS during
pandemic influenza emergencies, as determined by the Director-General, the Director-General may
temporarily modify the requirement to record all PIP biological materials. Such a modification must
be limited to the pandemic virus strain or strains connected with the emergency.
5.3.4 The Director-General shall report on any such modification to Member States.
5.4
Standard Material Transfer Agreements
5.4.1 The Standard Material Transfer Agreement 1 (SMTA 1) in Appendix 1 will be used to cover all
transfers of PIP biological materials within the WHO GISRS for the duration of its applicability.
5.4.2 The Director-General will, using the Standard Material Transfer Agreement 2 (SMTA 2) in
Appendix 2, enter into agreements with entities outside the WHO GISRS. Such agreements will cover
all transfers of PIP biological materials to recipients for their duration.
6. PANDEMIC INFLUENZA PREPAREDNESS
BENEFIT SHARING SYSTEM
6.0
General
6.0.1 Member States should, working with the WHO Secretariat, contribute to a pandemic influenza
benefit-sharing system and call upon relevant institutions, organizations, and entities, influenza
vaccines, diagnostics and pharmaceutical manufacturers and public health researchers to also make
appropriate contribution to this system.
6.0.2 The PIP Benefit Sharing System will operate to:
(i)
provide pandemic surveillance and risk assessment and early warning information and
services to all countries;
(ii) provide benefits, including, where appropriate, capacity building in pandemic
surveillance, risk assessment, and early warning information and services to Member States.
1
In November 2007 at the Intergovernmental Meeting on Pandemic Influenza Preparedness: sharing of influenza
viruses and access to vaccines and other benefits, the term “advisory mechanism” was substituted for the term “oversight
mechanism” used in resolution WHA60.28.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
(iii) prioritize important benefits, such as and including antiviral medicines and vaccines
against H5N1 and other influenza viruses with human pandemic potential as high priorities, to
developing countries, particularly affected countries, according to public health risk and needs
and particularly where those countries do not have their own capacity to produce or access
influenza vaccines, diagnostics and pharmaceuticals. Prioritization will be based on assessment
of public health risk and need, by experts with transparent guidelines;
(iv) build capacity in receiving countries over time for and through technical assistance and
transfer of technology, skills and know-how and expanded influenza vaccine production,
tailored to their public health risk and needs.
6.0.3 The pandemic influenza preparedness Benefit Sharing System will include the elements set out
in the remainder of this part.
6.1
WHO coordination of pandemic influenza preparedness and response
WHO will coordinate influenza pandemic preparedness and response in accordance with applicable
International Health Regulations (2005) provisions and this Framework. As regards the benefits
outlined in this Framework, WHO should pay particular attention to policies and practices that
promote the fair, equitable and transparent allocation of scarce medical resources (including, but not
limited to, vaccines, antivirals and diagnostic materials) during pandemics based on public health risk
and needs, including the epidemiology of the pandemic. During inter-pandemic periods, WHO will
work with Member States and relevant stakeholders to prepare for the aforementioned role.
6.2
Pandemic risk assessment and risk response
6.2.1 WHO GISRS laboratories will make available to the WHO Secretariat and the originating
Member State, in a rapid, systematic and timely manner, a summary report of laboratory analyses and
on request any other available information required regarding PIP biological materials to enable the
affected countries and in particular, developing countries, to make an effective and meaningful risk
response.
6.2.2 WHO will provide information on risk response including, but not limited to, information on
development of vaccines, candidate virus and effective antivirals to all affected countries and in
particular, to developing countries, to enable an effective and meaningful risk response.
6.2.3 The WHO Secretariat will make available to all Member States, in a rapid, systematic and
timely way, pandemic risk assessments and assist with risk response with all necessary supporting
information.
6.2.4 WHO Collaborating Centres on Influenza and WHO H5 Reference Laboratories and the
Director-General will actively continue to provide technical assistance to Member States to enhance
research and surveillance capacity, including staff training, with the objective of improving national
pandemic risk assessment and pandemic risk response.
6.3
Provision of PIP candidate vaccine viruses
6.3.1 The Director-General will ensure that WHO Collaborating Centres on Influenza/H5 Reference
Labs and Essential Regulatory Laboratories, as agreed in the terms of reference, provide PIP candidate
vaccine viruses upon request:
(i)
to influenza vaccine manufacturers on a no preference basis;
ANNEX 2
(ii)
at the same time to the laboratories of originating and other Member States;
(iii)
to any other laboratory.
83
6.3.2 Any entity receiving PIP candidate vaccine viruses will meet appropriate biosafety guidelines
(WHO Laboratory Biosafety Manual, 3rd edition) and employ laboratory protection best practices.
6.4
Provision of diagnostic reagents and test kits
6.4.1 WHO Collaborating Centres on Influenza, WHO H5 Reference Laboratories and Essential
Regulatory Laboratories, working with the WHO Secretariat, will continue to make available to
National Influenza Centres and Other authorized laboratories, without charge, supplies of
noncommercial diagnostic reagents and test kits for the identification and characterization of clinical
specimens of influenza.
6.4.2 Influenza diagnostic manufacturers receiving PIP biological materials are urged to make
available to WHO GISRS laboratories, without charge or at concessional and/or preferential rates,
supplies of diagnostic reagents and test kits for the identification and characterization of clinical
specimens of influenza, if circumstances warrant.
6.5
Provision of reference reagents for potency determination of vaccines
6.5.1 Essential Regulatory Laboratories will continue to provide, upon request, reference reagents for
potency determination of vaccines against H5N1 and other viruses of human pandemic potential to
national regulatory laboratories and influenza vaccine manufacturers of all Member States.
6.5.2 Essential Regulatory Laboratories will continue to provide upon request, training in quality
control of vaccines against H5N1 and other viruses of human pandemic potential to national
regulatory laboratories of all Member States.
6.6
Laboratory and influenza surveillance capacity building
6.6.1 Upon request, Member States with advanced laboratory and influenza surveillance capacity are
urged to continue to work with WHO and other Member States, particularly developing countries, to
develop national laboratory and influenza surveillance capacity, including:
(i)
to conduct early detection, isolation and characterization of viruses;
(ii)
to participate in pandemic risk assessment and response;
(iii)
to develop research capacity related to influenza;
(iv) to achieve technical qualifications for consideration of laboratories as National Influenza
Centres, WHO H5 Reference Laboratories and WHO Collaborating Centres on Influenza.
6.7
Regulatory capacity building
6.7.1 Upon request, Member States with advanced regulatory capacity should improve and strengthen
the work that has been undertaken by Member States with WHO, particularly in developing countries,
to strengthen the capacity of regulatory authorities to carry out the necessary measures for the rapid
approval of safe and effective human influenza vaccines, diagnostics and pharmaceutical products,
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
including products developed from the use of PIP biological materials, especially those derived from
new sub-types of influenza viruses.
6.7.2 Member States should make publicly available information on the notification of health
regulatory approval of vaccines, diagnostics and pharmaceutical products for H5N1 and other
influenza viruses with human pandemic potential, including those developed from the use of PIP
biological materials.
6.8
Antivirals stockpiles
6.8.1 The Director-General will continue to work with other multilateral agencies, donors,
international philanthropic organizations/entities, private foundations, and other potential partners,
including institutions, organizations and entities and in particular influenza vaccine, diagnostic and
pharmaceutical manufacturers, to seek commitments for contributions, maintain and further develop a
stockpile of antiviral medicines and associated equipment for use in containment of outbreaks of
H5N1 and other influenza viruses with human pandemic potential.
6.8.2 The Director-General will continue to coordinate with Member States, institutions,
organizations and other entities and encourage them to maintain and further develop stockpiles of
antiviral medicines and associated equipment for use in containment of outbreaks of H5N1 and other
influenza viruses with human pandemic potential.
6.8.3 The Director-General will continue to seek the guidance of expert advice in determining the
size, composition, replenishment, operational use and deployment procedures for use of the WHO
antivirals stockpile.
6.9
Pandemic influenza preparedness vaccine stockpile
6.9.1 The Director-General will establish and maintain a stockpile of vaccines for H5N1 and other
influenza viruses with human pandemic potential and associated equipment, including syringes,
needles and applicators, consistent with expert guidance.
6.9.2 The WHO stockpile will initially include 150 million doses of H5N1 vaccine for use in
accordance with expert guidance including the Strategic Advisory Group of Experts on immunization
(SAGE). Indicatively:
(i)
50 million doses will be for use in affected countries, according to public health risk and
need, to assist in containing the first outbreak or outbreaks of an emerging pandemic; and
(ii) 100 million doses will be for distribution, once a pandemic begins, to developing
countries that have no or inadequate access to H5N1 influenza vaccines, on a per capita basis,
with use to be determined by those countries.
6.9.3 Member States should urge influenza vaccine manufacturers to prioritize and respond to the
needs of the WHO PIP vaccine stockpile and to donate sufficient doses of vaccines for H5N1 to meet
its initial target (see 6.9.1 above).
6.9.4 The Director-General will continue to seek the guidance of experts in determining the size,
composition, replenishment and operational use of the vaccines in the WHO PIP vaccine stockpile for
H5N1 and other influenza viruses with human pandemic potential.
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6.9.5 If insufficient doses are donated, the Director-General will work with Member States to explore
the use of sustainable financing mechanisms (see 6.14 below) to meet the requirements of the WHO
PIP vaccine stockpile.
6.9.6 The Director-General will, with the guidance of experts, keep under review the potential for the
pre-pandemic use of the WHO PIP vaccine stockpile in affected countries, including by supporting
trials as appropriate.
6.9.7 The Director-General will work with relevant experts and Member States to develop and
exercise operational plans for the deployment of the vaccines in the WHO PIP vaccine stockpile.
6.10 Access to vaccines in the inter-pandemic period for developing countries
6.10.1 Separately from measures to support the WHO PIP vaccine stockpile set out in section 6.9
above:
(i)
Member States should urge influenza vaccine manufacturers to set aside a portion of each
production cycle of vaccines for H5N1 and other influenza viruses with human pandemic
potential for stockpiling and/or use, as appropriate, by developing countries; and
(ii) Member States should continue to work with each other, with the Director-General and
with influenza vaccine manufacturers, with the aim of ensuring that adequate quantities of
vaccines for H5N1 and other influenza viruses with human pandemic potential are made
available to developing countries at the same time as to developed countries, on the basis of
public health risk and needs and at tiered prices (see 6.12 below).
6.11 Access to pandemic influenza vaccines
6.11.1 Member States should urge vaccine manufacturers to set aside a portion of each production
cycle of pandemic influenza vaccine for use by developing countries; and
6.11.2 The Director-General, consulting Member States and the Advisory Group, will convene an
expert group to continue to develop international mechanisms, including existing ones, for the
production and distribution of influenza vaccines on the basis of public health risk and needs during a
pandemic, for consideration by the World Health Assembly in 2010.
6.12 Tiered pricing
As a measure to improve the affordability for developing countries of pandemic influenza vaccines
and vaccines for H5N1 and other influenza viruses with human pandemic potential, and antivirals,
Member States should urge influenza vaccine and antiviral manufacturers individually to implement
tiered pricing for these vaccines and antivirals. As part of this approach, influenza vaccine and
antiviral manufacturers individually should be urged to consider the income level of the country, and
negotiate with the national authorities of the recipient country, in arriving at the price to be applied in
the private and public markets of each country. In this context the vulnerability of the least developed
countries should be taken into account.
6.13 Technology transfer
6.13.1 The Director-General will continue to work closely with Member States and influenza vaccine
manufacturers to implement the WHO Global Pandemic Influenza Action Plan to Increase Vaccine
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Supply, including its strategies to build new production facilities in developing and/or industrialized
countries and through transfer of technology, skills and know-how.
6.13.2 Member States should urge influenza vaccine, diagnostic and pharmaceutical manufacturers to
make specific efforts to transfer these technologies to other countries, particularly developing
countries, as appropriate.
6.13.3 Technology transfer should be conducted in a manner consistent with applicable national laws
and international laws and obligations, facilitated progressively over time, on mutually agreed terms,
and be suitable to the capacity of recipient Member States, to empower developing countries to study
and manufacture influenza vaccines, diagnostics and pharmaceuticals.
6.13.4 Influenza vaccine manufacturers who receive PIP biological materials may grant, subject to any
existing licensing restrictions, on mutually agreed terms, a non-exclusive, royalty-free licence to any
influenza vaccine manufacturer from a developing country, to use its intellectual property and other
protected substances, products, technology, know-how, information and knowledge used in the
process of influenza vaccine development and production, in particular for pre-pandemic and
pandemic vaccines for use in agreed developing countries.
6.13.5 Member States seeking to receive technology to produce influenza vaccine should be
encouraged to first conduct studies on the disease burden of seasonal influenza with related economic
analysis in their country. Should the study warrant, Member States should be encouraged to consider
incorporating seasonal influenza vaccination into their national immunization programme, which will
enable sustainable functioning of the manufacturing facilities.
6.14 Sustainable and innovative financing mechanisms
6.14.1 With a view to ensuring the sustainable financing of the PIP Benefit Sharing System,
particularly for developing countries; and
6.14.2 Having regard to the desirability of all Member States and recipients of PIP biological materials
contributing to the PIP Benefit Sharing System, financially or in kind, according to their capacity and
over time.
6.14.3 Influenza vaccine, diagnostic and pharmaceutical manufacturers, using the WHO GISRS, will
make an annual partnership contribution to WHO for improving global pandemic influenza
preparedness and response. It is decided that the sum of the annual contributions shall be equivalent to
50% of the running costs of the WHO GISRS.1 Such contributions will commence in 2012. The
distribution between companies is to be based on transparency and equity, based on their nature and
capacities. The Director-General in consultation with the “Advisory Group” will further define the
specific amounts to be contributed by each company as well as the mechanism for implementation
(see section 6.14.5 below). In so doing, the Director-General and the “Advisory Group” will
collaborate with industry. The Director-General will report annually on the outcome to the Executive
Board.
1
The running costs of the GISRS for 2010 were approximately US$ 56.5 million. The running costs of the WHO
GISRS are understood to be a reference index for the partnership contribution of 50%. Such running costs may change over
time and the partnership contribution will change accordingly. Such running costs are not to include the partnership
contributions themselves.
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6.14.3.1 Member States and other stakeholders are encouraged to consider making donations and inkind contributions to WHO for improving global pandemic influenza preparedness and response.
6.14.4 The contribution acquired under 6.14.3 shall be used for improving pandemic preparedness and
response, inter alia, for conducting disease burden studies, strengthening laboratory and surveillance
capacity, access and effective deployment of pandemic vaccines and antiviral medicines.
6.14.5 The Director-General will propose to the Executive Board which proportion of contributions
should be used for inter-pandemic preparedness measures, and which proportion should be reserved
for response activities in the event of a pandemic, based on the advice of the “Advisory Group”.
6.14.6 The Director-General, based on advice from the “Advisory Group”, will decide on the use of
resources. The Director-General and the “Advisory Group” will interact with manufacturers and other
stakeholders.
6.14.7 Member States are urged to continue to support the speedy and successful implementation of
the WHO Global Pandemic Influenza Action Plan to Increase Vaccine Supply by 2015 by providing
adequate financial support in accordance with Framework sections 6.13.1 and 6.13.2.
6.14.8 Member States are urged to support the availability and rapid expansion of the safe use of
adjuvant technology through WHO as appropriate while at the same time strengthening the monitoring
of vaccine safety.
6.14.9 Member States are urged to continue and increase their support to strengthen laboratory and
surveillance capacity particularly in developing countries by providing adequate financial and
technical support in accordance with Framework section 6.6.
7. GOVERNANCE AND REVIEW
7.1
General
7.1.1 The implementation of this Framework will be overseen by the World Health Assembly with
advice from the Director-General.
7.1.2 An oversight mechanism is hereby established, which includes the World Health Assembly, the
Director-General and the independent “Advisory Group”, established in connection with the Interim
Statement of November 2007, and composed of international experts serving the Organization
exclusively. Respectively, their function will be as follows:
(i)
The Health Assembly, consistent with the Organization’s Constitutional function to act as
the “directing and co-ordinating” authority on international health work, as set forth in
Article 2(a) of the WHO Constitution, will oversee implementation of the Framework.
(ii) The Director-General, consistent with her role and responsibilities, particularly in
connection with collaborating institutions and other mechanisms of collaboration, inter alia, will
promote implementation of the Framework within WHO and among relevant WHO-related
entities.
(iii) In order that the Health Assembly and Director-General have appropriate expert
monitoring and evaluation processes to support these functions, the Advisory Group, as
provided for in this section, will provide evidence-based reporting, assessment and
recommendations regarding the functioning of the Framework. The Advisory Group, consistent
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with WHO practice regarding such independent expert bodies, will advise the Director-General
but will not itself engage in administrative functions, such as the recognition, or withdrawal of
recognition, of technical institutions, nor will it have a public role, except as authorized.
7.2
Advisory Group
7.2.1 The Director-General will maintain the Advisory Group, referenced in section 7.1.2 above, to
monitor and provide guidance to strengthen the functioning of the WHO GISRS and undertake
necessary assessment of the trust-based system needed to protect public health and to help ensure
implementation of this Framework.
7.2.2 The Director-General, in consultation with Member States, will continue to ensure that the
Advisory Group is based on equitable representation of the WHO regions and of affected countries,
taking into account balanced representation between developed and developing countries.
7.2.3 The Advisory Group will comprise 18 members drawn from three Member States in each WHO
Region, with a skill mix of internationally recognized policy-makers, public health experts and
technical experts in the field of influenza.
7.2.4 The Advisory Group will function to assist the Director-General in monitoring the
implementation of this Framework, in accordance with the terms of reference for the Advisory Group
in Appendix 3 of this Framework.
7.2.5 The Advisory Group will present an annual report to the Director-General on its evaluation of
the implementation of this Framework. The report should cover the following:
(i)
necessary technical capacities of WHO GISRS;
(ii)
operational functioning of WHO GISRS;
(iii) WHO GISRS influenza pandemic preparedness priorities, guidelines and best practices
(e.g. vaccine stockpiles, capacity building);
(iv) increasing and enhancing surveillance for H5N1 and other influenza viruses with human
pandemic potential;
(v)
the Influenza Virus Tracking Mechanism;
(vi)
the sharing of influenza viruses and access to vaccines and other benefits;
(vii) use of financial and non-financial contributions.
7.2.6 The Director-General will present a report on the work carried out by the Advisory Group,
through the Executive Board, to the Sixty-fifth World Health Assembly in 2012 for its consideration
including a decision on the Advisory Group’s future mandate.
7.3 Governance and review of terms of reference for WHO global influenza surveillance and
response system Laboratories
7.3.1 The terms of reference of the WHO Collaborating Centres on Influenza, WHO H5 Reference
Laboratories, National Influenza Centres and Essential Regulatory Laboratories should be developed
in accordance with the guiding principles outlined in Appendix 4 to this Framework.
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7.3.2 The Director-General, in consultation with the Advisory Group and competent authorities in
Member States, and the WHO Collaborating Centres, WHO H5 Reference Laboratories, National
Influenza Centres, and Essential Regulatory Laboratories, will review periodically the terms of
reference of the institutions and laboratories of the WHO GISRS and amend them when needed, to
promote the principles provided by this Framework, and report thereon to the World Health Assembly.
7.3.3 Member States may bring to the attention of the Director-General allegations of non-compliance
by institutions and laboratories of the WHO GISRS with their respective terms of reference or the
Standard Material Transfer Agreements.
7.3.4 In the event of any alleged breaches of the terms of reference or the Standard Material Transfer
Agreements by a WHO Collaborating Centre on Influenza, WHO H5 Reference Laboratories or
National Influenza Centre, and Essential Regulatory Laboratories, the Director-General will review
the circumstances and may discuss with the Advisory Group any appropriate action in response to
those breaches. Where there has been a serious breach, the Director-General may consider suspending
or revoking the WHO designation of the relevant laboratory.
7.4
Monitoring and review of the Pandemic Influenza Preparedness Framework
7.4.1 The Director-General shall on a biennial basis inform the World Health Assembly, through the
Executive Board, on the status of, and progress on:
(i)
Laboratory and surveillance capacity (see Framework section 6.6);
(ii) Global influenza vaccine production capacity (see Framework sections 6.13.1 and
6.13.2);
(iii) Status of agreements entered into with industry, including information on access to
vaccines, antivirals and other pandemic material (6.14.3 and 6.14.4);
(iv)
Financial report on the use of the partnership contribution (6.14.5);
(v) The experience arising from the use of the definition of PIP biological materials in
section 4.1.
7.4.2 The Framework and its Appendices will be reviewed by 2016 with a view to proposing
revisions reflecting developments as appropriate, to the World Health Assembly in 2017, through the
Executive Board.
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APPENDIX 1
Standard Material Transfer Agreement 1 (SMTA 1)
Standard Material Transfer Agreement within the WHO global influenza
surveillance and response system (GISRS)
In furtherance of the Pandemic Influenza Preparedness Framework for the sharing of influenza viruses
and access to vaccines and other benefits (the “Framework”), this Standard Material Transfer
Agreement (“Agreement” or “SMTA 1”) has been developed.
Article 1. Parties to the Agreement
1.1 Parties to SMTA 1 are limited to influenza laboratories that have been designated or recognized
by WHO and have accepted to work under agreed WHO terms of reference. In this Agreement:
The Provider is the laboratory sending Materials, as herein defined,
(name and address of the provider or providing institution, designation of the laboratory (i.e. whether
NIC/WHO CC/H5RL/ERL/other authorized laboratory), name of authorized official, contact
information for authorized official) (hereinafter referred to as “the Provider”)1
and
The Recipient is the laboratory receiving Materials, as herein defined,
(name and address of the recipient or recipient institution, designation of the laboratory (i.e. whether
NIC/WHO CC/H5RL/ERL/other authorized laboratory), name of authorized official, contact
information for authorized official) (hereinafter referred to as “the Recipient”)1
1.2
Provider and Recipient are hereafter collectively referred to as “Parties”.
Article 2. Subject matter of the Agreement
PIP biological materials as defined in Section 4.1 of the Framework (hereinafter “Materials”)
transferred from the Provider to the Recipient are subject to the provisions of this Agreement.
Article 3. General provisions
The Provider or recipient will consider support to the strengthening of the laboratory and surveillance
capacity of the networks of developing countries.
1
To be completed if signature is required pursuant to Article 11 below.
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Article 4. Rights and obligations of the Provider
4.1
The Provider undertakes the following with respect to the Materials:
4.1.1. To comply with its respective WHO global influenza surveillance and response system (GISRS)
terms of reference.
4.1.2. To ensure that the Materials are handled in accordance with applicable WHO guidelines and
national bio-safety standards.1
4.2. The Provider agrees to the onward transfer and use of the Materials, to all members of the WHO
GISRS, on the same terms and conditions as those provided in the Standard Material Transfer
Agreement within the WHO GISRS (SMTA 1).
4.3 The Provider consents to the onward transfer and use of the Materials to entities outside the
WHO GISRS on the condition that the prospective recipient has concluded a Standard Material
Transfer Agreement outside the WHO GISRS (SMTA 2).
4.4. The Provider shall inform the WHO of shipments of Materials to entities inside/outside the
WHO GISRS by recording in the Influenza Virus Tracking Mechanism (IVTM).
Article 5. Rights and obligations of the Recipient
5.1
The Recipient undertakes the following with respect to the Materials:
5.1.1 To comply with its respective WHO GISRS terms of reference.
5.1.2. To ensure that the Materials are handled in accordance with applicable WHO guidelines and
national bio-safety standards.
5.1.3. To inform WHO of shipments of Materials to entities inside/outside the WHO GISRS by
recording in the IVTM.
5.1.4 In the event of further transfers within the WHO GISRS, to do so in accordance with SMTA 1.
5.2. The Recipient shall actively seek the participation of scientists to the fullest extent possible
from originating laboratories and other authorized laboratories, especially those from developing
countries, in scientific projects associated with research on clinical specimens and/or influenza virus
from their countries and actively engage them in preparation of manuscripts for presentation and
publication.
5.3. The Recipient shall appropriately acknowledge in presentations and publications, the
contributions of collaborators, including laboratories/countries providing clinical specimens or
influenza virus with pandemic potential or reagents, using existing scientific guidelines.
1
“WHO Guidance on Regulations for the Transport of Infectious Substances”. Document WHO/CDS/EPR/2007.2.
Geneva, World Health Organization 2007 and “WHO Guidelines for the collection of human specimens for laboratory
diagnosis of avian influenza infection”.
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Article 6. Intellectual property rights
6.1 Neither the Provider nor the Recipient should seek to obtain any intellectual property rights
(IPRs) on the Materials.
6.2 The Provider and the Recipient acknowledge that any IPRs on the Materials obtained before the
date of adoption of the Framework by the World Health Assembly will not be affected by SMTA 1.
6.3 The Provider under SMTA 1 may have used technology protected by IPRs for the generation
and/or modification of the Materials. Any recipient of such Materials acknowledges that such IPRs
shall be respected.
Article 7. Dispute resolution
7.1. In the event of a dispute under SMTA 1, Parties concerned shall seek in the first instance to
settle the dispute through negotiation or any other amicable means of their own choice. Failure to
reach agreement shall not absolve the parties to the dispute from the responsibility of continuing to
seek to resolve it.
7.2. In the event that the dispute is not settled by the means described under paragraph 1 of this
Article, one of the Parties concerned may refer the dispute to the Director-General, who may seek
advice of the Advisory Group with a view to settling it. The Director-General may make
recommendations to the Parties regarding its resolution and shall report to the World Health Assembly
on any such matters.
7.3. The Parties also acknowledge the role of the Director-General under the Framework, in
particular under section 7.3.4.
Article 8. Warranty
The Provider makes no warranties as to the safety of the Materials, or as to the accuracy or correctness
of any data provided with them. Likewise, the provider does not make any warranties as to the quality,
viability, or purity (genetic or mechanical) of the Materials being furnished. The Provider and the
Recipient assume full responsibility for complying with their respective national biosecurity and
biosafety regulations and rules as to import, export or release of biological materials.
Article 9. Duration of Agreement
This contractual agreement shall remain in force until December 31, 2021 and shall be automatically
renewed until December 31, 2031 unless the World Health Assembly decides otherwise.
Article 10. Acceptance and Applicability
10.1. Recipients or Providers in the WHO GISRS at the time of the adoption of the Framework by the
World Health Assembly: Acceptance by such laboratories of their WHO terms of reference, as
contained in the Framework, constitutes acceptance of SMTA 1.
10.2 Recipients or Providers that join the WHO GISRS after adoption of the Framework by the
World Health Assembly: Acceptance of designation or recognition by WHO to become a WHO
GISRS laboratory will constitute acceptance of SMTA 1.
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10.3. Applicability: SMTA 1 shall cease to be applicable only upon suspension or revocation of
designation or recognition by WHO or upon formal withdrawal by the laboratory of its participation in
the WHO GISRS or upon mutual agreement of the WHO and the laboratory. Such a suspension,
revocation or withdrawal shall not relieve a laboratory of pre-existing obligations under SMTA 1.
Article 11. Signature
Further to Article 10 above entitled “Acceptance and Applicability”, unless either party requires this
Agreement to be executed by signature of a printed document, no further evidence of acceptance is
required.
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APPENDIX 2
Standard Material Transfer Agreement 2 (SMTA 2)
Standard Material Transfer Agreement outside the WHO global influenza
surveillance and response system (GISRS)
Article 1. Parties to the Agreement
WHO and Recipient.
1
Article 2. Subject matter of the Agreement
PIP biological materials as defined in Section 4.1 of the Framework (hereinafter “Materials”)
transferred to the Recipient are subject to the provisions of this Agreement.
Article 2. bis Definitions
(a) As provided for in Section 4 of the Pandemic Influenza Preparedness Framework for the
sharing of influenza viruses and access to vaccines and other benefits.
(b)
Other terms as agreed by the parties.
Article 3. Obligations of the Provider
To be agreed by the parties.
Article 4. Obligations of the Recipient
4.1 The recipient agrees to comply with the commitments selected below, in accordance with the
terms set out in the Annex to this agreement.
4.1.1 The recipient shall comply with the commitments selected on a timetable determined by WHO
in consultation with the Advisory Group established by the PIP Framework and in coordination with
the recipient, based on optimal pandemic preparedness and response considerations.
A.
For manufacturers of vaccines and/or antivirals, the recipient shall commit to at least two of the
following options:
A1.
Donate at least 10%2 of real time pandemic vaccine production to WHO.
1
Recipients are all entities that receive “PIP Biological Materials” from the WHO global influenza surveillance and
response system (GISRS), such as influenza vaccine, diagnostic and pharmaceutical manufacturers, as well as biotechnology
firms, research institutions and academic institutions. Each recipient shall select options based on its nature and capacities.
2
Recognizing that flexibility is important in negotiating with all manufacturers, in a range of 5–20%.
ANNEX 2
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A2. Reserve at least 10%1 of real time pandemic vaccine production at affordable prices to
WHO.
A3. Donate at least X treatment courses of needed antiviral medicine for the pandemic to
WHO.
A4. Reserve at least X treatment courses of needed antiviral medicine for the pandemic at
affordable prices.
A5. Grant to manufacturers in developing countries licenses on mutually agreed terms that
should be fair and reasonable including in respect of affordable royalties, taking into account
development levels in the country of end use of the products, on technology, know-how,
products and processes for which it holds IPR for the production of (i) influenza vaccines,
(ii) adjuvants, (iii) antivirals and/or (iv) diagnostics.
A6. Grant royalty-free licenses to manufacturers in developing countries or grant to WHO
royalty-free, non-exclusive licenses on IPR, which can be sublicensed, for the production of
pandemic influenza vaccines, adjuvants, antivirals products and diagnostics needed in a
pandemic. WHO may sublicense these licenses to manufacturers in developing countries on
appropriate terms and conditions and in accordance with sound public health principles.
Where Option 5 or 6 is selected, the Recipient shall regularly provide to WHO information on
granted licenses and the status of implementation of the licensing agreement. WHO shall
provide such information to the Advisory Group.
B.
Manufacturers of products relevant to pandemic influenza preparedness and response, that are
not manufacturing vaccines or antivirals, shall commit to one of the following options: A5, A6, B1,
B2, B3, B4.
B1.
Donate to WHO at least X2 diagnostic kits needed for pandemics.
B2.
Reserve for WHO at least X2 diagnostic kits needed for pandemics, at affordable prices.
B3. Support, in coordination with WHO, the strengthening of influenza specific laboratory
and surveillance capacity in developing countries.
B4. Support, in coordination with WHO, transfer of technology, know-how and/or processes
for pandemic influenza preparedness and response in developing countries.
C.
The recipient shall, in addition to the commitments selected under A or B above, consider
contributing to the measures listed below, as appropriate:
• Donations of vaccines;
• Donations of pre-pandemic vaccines;
• Donations of antivirals;
• Donations of medical devices;
1
Recognizing that flexibility is important in negotiating with all manufacturers, in a range of 5–20%.
2
Recognizing that flexibility is important in negotiating with all manufacturers.
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• Donations of diagnostic kits;
• Affordable pricing;
• Transfer of technology and processes;
• Granting of sublicenses to WHO;
• Laboratory and surveillance capacity building.
4.2 The Recipient shall ensure that the PIP biological materials are handled in accordance with
applicable WHO guidelines and national bio-safety standards.
4.3 If applicable, the Recipient shall appropriately acknowledge in presentations and publications,
the contributions of WHO laboratories providing the materials identified in Article 2, using existing
scientific guidelines.
4.4 The recipient shall only further transfer the PIP biological materials if the prospective recipient
has concluded an SMTA with the World Health Organization. Any such further transfer shall be
reported to the World Health Organization. The Director-General may, under exceptional
circumstances, allow the PIP biological materials to be transferred to a prospective recipient while
requesting this aforementioned recipient to enter into an SMTA, and report to the “Advisory Group”
accordingly.
4.5 The recipient may exchange PIP biological materials with any other holder of an SMTA
concluded with the World Health Organization.
Article 5. Dispute resolution
If a dispute cannot be resolved through negotiations or other non-binding means of the parties’ choice,
disputes shall be subject to binding arbitration on conditions that are mutually agreed by the parties.
Article 6. Liability and indemnity
To be agreed by the parties.
Article 7. Privileges and immunity
Nothing in or relating to these clauses shall imply the obligation of WHO to submit to any national
legislation or jurisdiction, or be deemed a waiver of any of the privileges and immunities of WHO in
conformity with the Convention on the Privileges and Immunities of the Specialized Agencies
approved by the General Assembly of the United Nations on November 21, 1947 or otherwise under
any national or international law, convention or agreement.
Article 8. Name and Emblem
To be agreed by the parties.
Article 9. Warranties
To be agreed by the parties.
Article 10. Duration of Agreement
To be agreed by the parties.
Article 11. Termination
To be agreed by the parties.
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Article 12. Force Majeure
To be agreed by the parties.
Article 13. Governing law
To be agreed by the parties.
Article 14. Signature and Acceptance
In WITNESS Whereof, this Agreement has been duly executed by the parties.
SIGNED for and on behalf of WHO
SIGNED for and on behalf of Recipient
Signature
Signature
Name
Name
Title
Title
*********************
Annex*
To be agreed by the parties.
* Editor’s note: the annex is to be developed, as necessary, by the parties.
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APPENDIX 3
ADVISORY GROUP
TERMS OF REFERENCE
(Adopted by the Intergovernmental Meeting at its resumed session in December 2008, as amended by
the Open-Ended Working Group of Member States on Pandemic Influenza Preparedness: sharing of
influenza viruses and access to vaccines and other benefits in April 2011.)
1.
Background and mandate of the Advisory Group
1.1 The Interim Statement adopted by WHO Member States attending the session of the
Intergovernmental Meeting on Pandemic Influenza Preparedness, 20–23 November 2007, urged action
to develop fair, transparent, and equitable international mechanisms on virus sharing and benefit
sharing. Member States called on the Director-General to establish an Advisory Mechanism to
monitor, provide guidance to strengthen the functioning of the trust-based system needed to protect
public health and undertake necessary assessment of that system. To carry this out, Member States
specified that an Advisory Group will be appointed by the Director-General in consultation with
Member States, based on equitable representation of the WHO regions and of affected countries.
1.2 The trust-based system is now referred to as the “Pandemic Influenza Preparedness Framework
for the sharing of influenza viruses and access to vaccines and other benefits” (hereinafter “the
Framework”). The scope of the Advisory Group is to monitor, assess and report on the system for
sharing H5N1 influenza viruses and other influenza viruses with human pandemic potential as well as
access to vaccines and other benefits of the Framework. The institutional components of the
Framework to be monitored by the Advisory Group are National Influenza Centres, Other authorized
laboratories, WHO Collaborating Centres, H5 Reference Laboratories, and Essential Regulatory
Laboratories, as defined in Section 4 of the Framework. The pharmaceutical industry, although not
included, can be consulted by the Advisory Group.
2.
Functions of the Advisory Group
2.1 To monitor, assess and report on how the different functions of the Framework are implemented
by its components. The information to conduct these tasks should be provided by the WHO Secretariat
and other independent sources, if available. Monitoring by the Advisory Group will enable ongoing
assessment of the functioning of the Framework and should include at least:
(a) the rapid, systematic and timely sharing of H5N1 and other influenza viruses with human
pandemic potential with the WHO global influenza surveillance and response system (GISRS);
(b)
the Influenza Virus Traceability Mechanism;
(c) the global improvement of laboratory capacity, particularly in developing countries, to
enhance pandemic influenza preparedness;
(d)
the fair and equitable sharing of benefits;
(e)
the use of financial and non-financial contributions.
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2.2 To carry out the necessary assessment of the Framework according to quantitative and
qualitative indicators developed from information provided by the WHO Secretariat and other
independent sources, if necessary.
2.3
To provide guidance to strengthen the functioning of the Framework to the Director-General.
2.4 To make recommendations to the Director-General on the use of financial and non-financial
contributions.
2.5
Recommendations and reports of the Advisory Group shall be evidence based.
2.6 To present an annual report to the Director-General on its evaluation of the implementation of
this Framework. The report should cover the following:
(a)
necessary technical capacities of WHO GISRS;
(b)
operational functioning of WHO GISRS;
(c) WHO GISRS influenza pandemic preparedness priorities, guidelines and best practices
(e.g. vaccine stockpiles, capacity building);
(d) increasing and enhancing surveillance for H5N1 and other influenza viruses with human
pandemic potential;
3.
(e)
the Influenza Virus Tracking Mechanism;
(f)
the sharing of influenza viruses and access to vaccines and other benefits;
(g)
use of financial and non-financial contributions.
Nomination of members
3.1 The Advisory Group will comprise 18 members drawn from three Member States in each WHO
region, with a skill mix of internationally recognized policy-makers, public health experts and
technical experts in the field of influenza. In the exercise of their functions the Members shall act as
international experts serving WHO exclusively.
3.2 Each member will serve for three years. The duration of appointment of each member will be
three years with a renewal of one third of the members every year; replacements must maintain the
equitable representation of the six WHO regions and affected countries; all members will be eligible
for two appointments. In the event of resignation or incapacity of a member for any reason, the
Director-General will appoint a replacement member with a view to maintaining the equitable
representation of the six WHO regions and affected countries. The replacement will complete the term
of the previous member. The Group will select from among its members, a Chairperson and a ViceChairperson. The Chairperson and Vice-Chairperson will serve for two years after which another
Chairperson and Vice-Chairperson will be selected by the Group members.
3.3 The Director-General will regularly accept nominations of representatives and will draw from
this list to replace outgoing members with a view to maintaining the equitable representation of the six
WHO regions and affected countries.
100
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Working procedures
4.1 The Director-General will apply to this Advisory Group working procedures consistent with
WHO’s practices and procedures.
4.2 The Regulations for Expert Advisory Panels and Committees will apply to the Advisory Group,
including with respect to the private nature of meetings. Furthermore, members of the Advisory Group
will not make public statements, individually or on behalf of the Group, on the work of the Advisory
Group, except as authorized in connection with reporting requirements or by the Director-General.
5.
Resources for implementation
The Director-General will make available the necessary human and financial resources to support the
work of the Advisory Group.
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101
APPENDIX 4
GUIDING PRINCIPLES FOR THE DEVELOPMENT OF TERMS OF REFERENCE
FOR CURRENT AND POTENTIAL FUTURE WHO GLOBAL INFLUENZA
SURVEILLANCE AND RESPONSE SYSTEM (GISRS) LABORATORIES
FOR H5N1 AND OTHER HUMAN PANDEMIC INFLUENZA VIRUSES
The specific roles, responsibilities and activities conducted by the different WHO global influenza
surveillance and response system (GISRS) laboratories can differ depending on whether they are a
National Influenza Centre, a WHO Collaborating Centre, an H5 Reference Laboratory or an essential
regulatory laboratory. However, in the context of pandemic influenza preparedness and their work
with H5N1 and other viruses of human pandemic potential, the development of the terms of reference
for each group of WHO GISRS laboratories shall comply with the following core guiding principles.
1.
All activities conducted by WHO GISRS laboratories under their WHO terms of reference will
be consistent with the Framework and the Standard Material Transfer Agreement.*
2.
The WHO GISRS laboratories will be coordinated by, and provide support to, WHO.
3.
The WHO GISRS laboratories will provide a timely summary report of laboratory analyses and
on request any other available information on tests conducted, test results and associated risk
assessment and risk response as is specified in their terms of reference.
4.
The WHO GISRS laboratories will share experience and provide capacity-strengthening support
to WHO Member States within their resources where necessary.
5.
The WHO GISRS laboratories will provide support as specified in their terms of reference for
the development of potential pandemic vaccine, pandemic vaccine, diagnostic test materials and
pharmaceuticals.
6.
If WHO GISRS laboratories conduct research on influenza viruses received for public health
surveillance purposes, they will do so in a manner that includes participation of scientists, to the fullest
extent possible, from the submitting National Influenza Centre or Other authorized laboratory,
especially those from developing countries, including through the publication process.
7.
The WHO GISRS laboratories will support global public health preparedness and response,
especially for urgent situations including international outbreaks and epidemics.
8.
The WHO GISRS laboratories will share in a rapid, systematic and timely manner PIP
biological materials, using the Influenza Virus Traceability Mechanism as appropriate, including
distribution to other qualified laboratories, to facilitate public health risk assessment, risk response
activities and scientific research in accordance with the Standard Material Transfer Agreement.*
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
9.
The WHO GISRS laboratories will submit genetic sequences data to GISAID and Genbank or
similar databases in a timely manner consistent with the Standard Material Transfer Agreement.*
10. The originating laboratories which provide the PIP biological materials received by the WHO
GISRS laboratories will be given due credit and recognition.
ANNEX 2
103
APPENDIX 5
WHO COLLABORATING CENTRES FOR INFLUENZA
TERMS OF REFERENCE RELATED TO WORK WITH PANDEMIC
INFLUENZA PREPAREDNESS BIOLOGICAL MATERIALS
BACKGROUND
The WHO global influenza surveillance and response system (GISRS) serves as a global alert
mechanism for the emergence of influenza viruses with important features, including those with
pandemic potential. For activities related to pandemic influenza, the WHO GISRS includes four
complementary categories of institutions and laboratories: National Influenza Centres, WHO
Collaborating Centres, WHO H5 Reference Laboratories and Essential Regulatory Laboratories. The
WHO GISRS is coordinated by the WHO Global Influenza Programme. Within each category all
institutions and laboratories perform functions defined by core terms of reference. The core terms of
reference for WHO Collaborating Centres are the minimum requirements that must be met by each
WHO Collaborating Centre and the capacity to fulfil these is a prerequisite to designation as a WHO
Collaborating Centre. Each laboratory or institution that is formally recognized or designated as a part
of WHO GISRS by WHO has accepted to be bound by the core terms of reference applicable to its
category. The following are the core terms of reference applicable to the WHO Collaborating Centres.
In addition, individual WHO Collaborating Centres within the WHO GISRS may have additional
specific terms of reference, where appropriate. The specific terms of reference recognize that there are
differences in expertise, capacities and interests among the WHO Collaborating Centres and provide
for individual WHO Collaborating Centres to perform additional functions related to pandemic risk
assessment and response. Specific terms of reference will be discussed with and agreed upon between
the WHO Collaborating Centre and the WHO Global Influenza Programme before the WHO
Collaborating Centre’s designation and redesignation.
In general, the WHO Collaborating Centres conduct influenza pandemic risk assessment on an
ongoing basis and provide advice, expertise and support to Member States and the Secretariat to
facilitate activities in response to influenza risks. The WHO Collaborating Centres support outbreak
investigation, conduct comprehensive virus analyses, and select and develop candidate influenza
vaccine viruses with pandemic potential. The efficient implementation of pandemic influenza risk
assessment and risk response is based on the collective efforts of all WHO GISRS members and
through the rapid sharing of biological materials, reference reagents, epidemiologic data and other
information.
It is understood that the Guiding Principles, as agreed by the Intergovernmental Meeting and
reproduced below, will guide all activities, specific terms of reference or associated functions of the
WHO GISRS laboratories when they act in their capacity as a WHO GISRS laboratory. The terms of
reference for all WHO GISRS laboratories have been developed under the following overarching
Guiding Principles:
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Guiding Principles for the development of terms of reference for current and potential
future WHO global influenza surveillance and response system (GISRS) laboratories for
H5N1 and other human pandemic influenza viruses
1.
All activities conducted by WHO GISRS laboratories under their WHO terms of reference will
be consistent with the Framework and the Standard Material Transfer Agreement.*
2.
The WHO GISRS laboratories will be coordinated by, and provide support to, WHO.
3.
The WHO GISRS laboratories will provide a timely summary report of laboratory analyses and
on request any other available information on tests conducted, test results and associated risk
assessment and risk response as is specified in their terms of reference.
4.
The WHO GISRS laboratories will share experience and provide capacity strengthening support
to WHO Member States within their resources where necessary.
5.
The WHO GISRS laboratories will provide support as specified in their terms of reference for
the development of potential pandemic vaccine, pandemic vaccine, diagnostic test materials and
pharmaceuticals.
6.
If WHO GISRS laboratories conduct research on influenza viruses received for public health
surveillance purposes, they will do so in a manner that includes participation of scientists, to the fullest
extent possible, from the submitting National Influenza Centre or other authorized laboratory,
especially those from developing countries, including through the publication process.
7.
The WHO GISRS laboratories will support global public health preparedness and response,
especially for urgent situations including international outbreaks and epidemics.
8.
The WHO GISRS laboratories will share in a rapid, systematic and timely manner biological
materials related to pandemic influenza preparedness, using the Influenza Virus Traceability
Mechanism as appropriate, including distribution to other qualified laboratories, to facilitate public
health risk assessment, risk response activities and scientific research in accordance with the Standard
Material Transfer Agreement.*
9.
The WHO GISRS laboratories will submit genetic sequences data to GISAID and Genbank or
similar databases in a timely manner consistent with the Standard Material Transfer Agreement.*
10. The originating laboratories which provide the PIP biological materials received by the WHO
GISRS laboratories will be given due credit and recognition.
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
ANNEX 2
105
Core terms of reference
WHO Collaborating Centres for Influenza are centres of excellence on influenza which are designated
by WHO and which agree to the following:
A.
General conditions and activities
WHO Collaborating Centres for Influenza:
1.
work under the coordination of the WHO Global Influenza Programme, and provide support to
WHO (Guiding Principles 2, 7);
2.
fulfil the core terms of reference and specific terms of reference using financial support
provided only by governmental and/or other non-commercial sources;
3.
use the WHO Influenza Virus Traceability Mechanism to record the receipt and transfer of PIP
biological materials (Guiding Principle 8);
4.
comply with the Standard Material Transfer Agreement* of the Pandemic Influenza
Preparedness Framework for sharing of influenza viruses and access to vaccines and other benefits
(Guiding Principle 1);
5.
maintain the capacity to exchange materials and information on a regular and timely basis with
other WHO Collaborating Centres (Guiding Principles 3, 8);
6.
have full and unrestricted access to biosafety level 3 laboratory facilities that meet recognized
international and national standards. The Provider assumes full responsibility for complying with their
respective national biosecurity and biosafety regulations on the understanding that such regulations
and rules shall, at a minimum, meet the relevant and current WHO standards;
7.
serve as a technical resource to WHO for any other urgent issues related to pandemic influenza
or influenza outbreaks with pandemic potential (Guiding Principles 2, 5);
8.
appropriately acknowledge the originating laboratories providing clinical specimens and/or
influenza viruses with pandemic potential (Guiding Principles 8, 10);
9.
maintain and strengthen active communication and collaboration with National Influenza
Centres1 and WHO to ensure that up-to-date information and findings of public health significance are
rapidly exchanged (Guiding Principles 3, 4, 7, 8);
10. alert WHO and the country from which clinical specimens and/or viruses with pandemic
potential were provided, on unusual findings related to pandemic influenza risk assessment (Guiding
Principles 3, 7);
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
1
WHO-designated National Influenza Centres.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
11. provide expertise and laboratory support when requested by WHO, to assist Member States, and
in particular developing countries, in responding to outbreaks of influenza viruses with pandemic
potential and risk assessment (Guiding Principles 2, 3, 4, 7);
12. provide training and laboratory support to National Influenza Centres, especially those in
developing countries, on laboratory techniques and skills, including diagnosis, data analyses, risk
assessment and other critical capacities (Guiding Principle 4);
13. assist WHO in improving global surveillance for influenza viruses with pandemic potential
(Guiding Principles 2, 7) including the development of standards, recommendations and policies as
well as improving associated outbreak response and pandemic preparedness (Guiding Principles 2, 3,
4, 7);
14. provide regular and timely surveillance data and results of virus characterization to originating
laboratories and to WHO (Guiding Principle 3, 7);
15. advise the WHO GISRS on laboratory methods for diagnosis of influenza viruses with
pandemic potential, including the adoption of new diagnostic approaches, the improvement of
laboratory practices and other operational needs (Guiding Principles 2, 3, 5).
B.
Laboratory analyses and related activities
WHO Collaborating Centres for Influenza:
1.
conduct accurate laboratory diagnosis, typing and subtyping, and confirmation of
influenza A(H5) and other influenza viruses with pandemic potential for specimens received (Guiding
Principles 2, 3, 7);
2.
conduct isolation of influenza viruses with pandemic potential in embryonated eggs and cell
culture;
3.
conduct detailed antigenic and genetic analyses of influenza viruses with pandemic potential
and make the results available to WHO and the originating laboratories in a timely manner (Guiding
Principles 2, 3, 4, 7);
4.
share available haemagglutinin, neuraminidase and other gene sequences of A(H5) and other
influenza viruses with pandemic potential immediately with the originating laboratory, WHO
Collaborating Centres and H5 Reference Laboratories (Guiding Principle 3);
5.
upload available haemagglutinin, neuraminidase and other gene sequences of A(H5) and other
influenza viruses with pandemic potential to a publicly accessible database in a timely manner but no
later than three months after sequencing is completed, unless otherwise instructed by the laboratory or
country providing the clinical specimens and/or viruses (Guiding Principle 9);
6.
produce and distribute ferret antisera against influenza viruses with pandemic potential to WHO
laboratories involved in influenza vaccine virus selection and development (Guiding Principle 5);
7.
conduct analyses, provide data and advice to WHO and participate in meetings and
teleconferences concerning the selection, development and timely availability of candidate vaccine
viruses for H5N1 and other influenza viruses with pandemic potential (Guiding Principles 2, 5, 7);
ANNEX 2
107
8.
participate in the development of candidate influenza vaccine viruses for pandemic influenza
preparedness and response (Guiding Principles 5, 7);
9.
conduct antiviral susceptibility testing of H5N1 and other influenza viruses with pandemic
potential and provide timely reports to the originating laboratories and WHO (Guiding Principle 3);
10. select, maintain and update a group of reference influenza viruses with pandemic potential,
including H5N1, and corresponding antisera if available and update the availability of candidate
influenza vaccine viruses and corresponding antisera, if any, to WHO (Guiding Principles 2, 3, 5, 7);
11. develop, update and produce laboratory diagnostic reagents for influenza H5N1 and other
viruses with pandemic potential directly or through contracted entities, and distribute them to National
Influenza Centres subject to the availability of resources (Guiding Principle 5);
12. share in a timely manner clinical specimens and influenza viruses with pandemic potential in
accordance with the Standard Material Transfer Agreement* with laboratories working in coordination
and collaboration with the WHO Global Influenza Programme, including:
(i)
other WHO Collaborating Centres (Guiding Principles 1, 8);
(ii) essential regulatory laboratories that are involved in the WHO process of candidate
influenza vaccine virus selection and development, as well as vaccine potency reagent
development (Guiding Principles 1, 8);
(iii) other laboratories involved in WHO coordinated specialized activities (e.g. the WHO
External quality assessment project for the detection of subtype influenza A viruses using
polymerase chain reaction; the WHO influenza polymerase chain reaction primer updating), and
other activities whose purpose is to strengthen global influenza surveillance and other risk
assessment and risk response; as well as capacity building (Guiding Principles 1, 4, 8);
13. select candidate influenza vaccine viruses under the coordination of WHO, for development and
production of vaccines against influenza viruses with pandemic potential. Depending on the vaccine
production process, the candidate influenza vaccine viruses can include wild type viruses and highgrowth reassortant viruses, including those prepared by reverse genetics. Distribute candidate
influenza vaccine viruses to appropriate recipients with appropriate biosafety level capacity on request,
including influenza vaccine manufacturers, diagnostic companies, research institutes and others
interested in receiving influenza vaccine viruses (Guiding Principles 5, 8);
14. select, maintain and update reference A(H5N1) and other influenza viruses with pandemic
potential as antigenically and genetically representative of important groups of viruses. Subject to the
availability of resources, distribute both reference viruses and corresponding antisera, on request, to
National Influenza Centres and other institutes for non-commercial activities including surveillance,
and reference and research (Guiding Principle 10);
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
108
C.
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Research and scientific presentations and publications
WHO Collaborating Centres for Influenza:
1.
actively seek the participation of scientists from originating laboratories/countries in scientific
projects associated with research on clinical specimens and/or influenza viruses from their countries
and actively engage them in preparation of manuscripts for presentation and publication (Guiding
Principle 6);
2.
appropriately acknowledge in presentations and publications, the contributions of collaborators,
including laboratories/countries providing clinical specimens or influenza viruses with pandemic
potential or reagents, using guidelines such as those outlined by the International Committee of
Medical Journal Editors1 (Guiding Principle 6).
Specific terms of reference
These are additional functions attributed to an individual WHO Collaborating Centre in the light of its
specific expertise in the field of influenza.
1
See http://www.icmje.org/.
ANNEX 2
109
NATIONAL INFLUENZA CENTRES
TERMS OF REFERENCE RELATED TO WORK WITH PANDEMIC
INFLUENZA PREPAREDNESS BIOLOGICAL MATERIALS
BACKGROUND
The WHO global influenza surveillance and response system (GISRS) serves as a global alert
mechanism for the emergence of influenza viruses with important features, including those with
pandemic potential. For activities related to pandemic influenza, the WHO GISRS includes four
complementary categories of institutions and laboratories: National Influenza Centres, WHO
Collaborating Centres, WHO H5 Reference Laboratories and Essential Regulatory Laboratories. The
WHO GISRS is coordinated by the WHO Global Influenza Programme. Within each category all
institutions and laboratories perform functions defined by core terms of reference. Each laboratory or
institution that is formally recognized or designated as a part of the WHO GISRS by WHO has
accepted to be bound by the core terms of reference applicable to its category. The following are the
core terms of reference applicable to the National Influenza Centres.
National Influenza Centres play a key role in pandemic influenza risk assessment by alerting WHO
immediately to outbreaks of H5N1 or other influenza viruses with pandemic potential. National
Influenza Centres collect specimens from suspected cases of H5N1 or other unusual influenza viral
infection, perform laboratory diagnosis and analysis, and ship in a timely manner, such specimens or
viruses isolated from them, to a WHO Collaborating Centre or H5 Reference Laboratory for advanced
virological analysis. Efficient pandemic influenza risk assessment and risk response are based on
collective efforts from all WHO GISRS members through rapid exchange of biological materials,
reference reagents, epidemiologic data and other information.
It is understood that the Guiding Principles, as agreed by the Intergovernmental Meeting and
reproduced below, will guide all activities, specific terms of reference or associated functions of the
WHO GISRS laboratories when they act in their capacity as a WHO GISRS laboratory. The terms of
reference for all WHO GISRS laboratories have been developed under the following overarching
Guiding Principles:
Guiding Principles for the development of terms of reference for current and potential future
WHO global influenza surveillance and response system (GISRS) laboratories for H5N1 and
other human pandemic influenza viruses
1.
All activities conducted by WHO GISRS laboratories under their WHO terms of reference will
be consistent with the Framework and the Standard Material Transfer Agreement.*
2.
The WHO GISRS laboratories will be coordinated by, and provide support to, WHO.
3.
The WHO GISRS laboratories will provide a timely summary report of laboratory analyses and
on request any other available information on tests conducted, test results and associated risk
assessment and risk response as is specified in their terms of reference.
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
4.
The WHO GISRS laboratories will share experience and provide capacity strengthening support
to WHO Member States within their resources where necessary.
5.
The WHO GISRS laboratories will provide support as specified in their terms of reference for
the development of potential pandemic vaccine, pandemic vaccine, diagnostic test materials and
pharmaceuticals.
6.
If WHO GISRS laboratories conduct research on influenza viruses received for public health
surveillance purposes, they will do so in a manner that includes participation of scientists, to the fullest
extent possible, from the submitting National Influenza Centre or other authorized laboratory,
especially those from developing countries, including through the publication process.
7.
The WHO GISRS laboratories will support global public health preparedness and response,
especially for urgent situations including international outbreaks and epidemics.
8.
The WHO GISRS laboratories will share in a rapid, systematic and timely manner PIP
biological materials, using the Influenza Virus Traceability Mechanism as appropriate, including
distribution to other qualified laboratories, to facilitate public health risk assessment, risk response
activities and scientific research in accordance with the Standard Material Transfer Agreement.*
9.
The WHO GISRS laboratories will submit genetic sequences data to GISAID and Genbank or
similar databases in a timely manner consistent with the Standard Material Transfer Agreement.*
10. The originating laboratories which provide the PIP biological materials received by the WHO
GISRS laboratories will be given due credit and recognition.
Core terms of reference
National Influenza Centres are laboratories that fulfil the terms of reference listed below. A National
Influenza Centre is formally designated by the health ministry of the country concerned and is
recognized by WHO. A National Influenza Centre may have additional obligations under the authority
of its ministry of health.
A.
General conditions and activities
National Influenza Centres:
1.
work under the coordination of the WHO Global Influenza Programme and provide support to
WHO (Guiding Principles 2, 7);
2.
use the WHO Influenza Virus Traceability Mechanism to record the receipt and transfer of PIP
biological materials (Guiding Principle 8);
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
ANNEX 2
111
3.
comply with the Standard Material Transfer Agreement* of the Pandemic Influenza
Preparedness Framework for sharing of influenza viruses and access to vaccines and other benefits
(Guiding Principle 1);
4.
serve as a key point of contact between WHO and the country of the National Influenza Centre
on issues related to surveillance, laboratory diagnosis, and sharing of clinical specimens and/or
influenza viruses with pandemic potential, as well as sharing of important related clinical or
epidemiological information, when available, with WHO (Guiding Principles 2, 3, 4, 7, 8);
5.
participate actively in WHO pandemic influenza surveillance activities and maintain active
communication and collaboration with other members of the WHO GISRS (Guiding Principles 4, 7, 8).
B.
Laboratory and related activities
National Influenza Centres:
1.
collect or process as appropriate clinical specimens from patients suspected to be infected with
H5N1 and other influenza viruses with pandemic potential (Guiding Principle 7);
2.
act as a collection point for virus isolates of suspected pandemic influenza from laboratories
within the country;
3.
conduct testing of clinical specimens for influenza viruses and detect influenza viruses that
cannot be readily identified with diagnostic reagents provided through the WHO GISRS;
4.
ship, within one week, clinical specimens and/or viruses that cannot be readily identified with
diagnostic reagents provided through the WHO GISRS to a WHO Collaborating Centre or
H5 Reference Laboratory of their choice and include the date the specimen was collected and relevant
geographical, epidemiological and clinical information (Guiding Principles 2, 3, 5, 7, 8);
5.
attend laboratory training courses provided by the WHO Collaborating Centres in an effort to
establish and maintain capacity to recognize influenza viruses that cannot be readily identified
(Guiding Principle 4);
6.
review, maintain and strengthen influenza surveillance in the country (Guiding Principle 2);
7.
provide technical advice and support to other influenza laboratories in the country on specimen
collection and shipment logistics, laboratory biosafety and other operational procedures related to
influenza surveillance (Guiding Principles 2, 7).
C.
Information and communication
National Influenza Centres:
1.
alert WHO immediately when influenza viruses are detected that cannot be readily identified
with diagnostic reagents provided through the WHO GISRS or when unusual outbreaks of
non-seasonal influenza or influenza-like illness emerge;
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
2.
provide national authorities and the general public with information on H5N1 and other
influenza viruses with pandemic potential circulating in the country in a timely manner.
D.
Research, scientific presentations and publications
National Influenza Centres:
1.
actively seek the participation of scientists from originating laboratories/countries in scientific
projects associated with research on clinical specimens and/or influenza viruses from their countries
and actively engage them in preparation of manuscripts for presentation and publication (Guiding
Principle 6);
2.
appropriately acknowledge in presentations and publications, the contributions of collaborators,
including laboratories/countries providing clinical specimens or influenza viruses with pandemic
potential or reagents, using guidelines such as those outlined by the International Committee of
Medical Journal Editors1 (Guiding Principle 6).
1
See http://www.icmje.org/.
ANNEX 2
113
WHO H5 REFERENCE LABORATORIES
TERMS OF REFERENCE RELATED TO WORK WITH PANDEMIC
INFLUENZA PREPAREDNESS BIOLOGICAL MATERIALS
BACKGROUND
The WHO global influenza surveillance and response system (GISRS) serves as a global alert
mechanism for the emergence of influenza viruses with important features, including those with
pandemic potential. For activities related to pandemic influenza, the WHO GISRS includes four
complementary categories of institutions and laboratories: National Influenza Centres, WHO
Collaborating Centres, WHO H5 Reference Laboratories and Essential Regulatory Laboratories. The
WHO GISRS is coordinated by the WHO Global Influenza Programme. Within each category all
institutions and laboratories perform functions defined by core terms of reference. The core terms of
reference for WHO H5 Reference Laboratories are the minimum requirements that must be met by
each WHO H5 Reference Laboratory and the capacity to fulfil these is a prerequisite to designation as
a WHO H5 Reference Laboratory. Each laboratory or institution that is formally recognized or
designated as a part of the WHO GISRS by WHO has accepted to be bound by the core terms of
reference applicable to its category. The following are the core terms of reference applicable to the
WHO H5 Reference Laboratories.
WHO H5 Reference Laboratories are laboratories that were designated by WHO on an ad hoc basis
commencing in 2005, to support the WHO GISRS in response to the emergence and spread of highly
pathogenic avian influenza H5N1. These laboratories conduct influenza risk assessment and response
by providing reliable laboratory diagnosis of influenza infection in humans, especially those suspected
of being associated with avian influenza A(H5) viruses or other influenza viruses with pandemic
potential. Efficient influenza risk assessment and risk response are based on collective efforts from all
WHO GISRS members through rapid exchange of biological materials, reference reagents,
epidemiologic data and other information.
It is understood that the Guiding Principles, as agreed by the Intergovernmental Meeting and
reproduced below, will guide all activities, specific terms of reference or associated functions of the
WHO GISRS laboratories when they act in their capacity as a WHO GISRS laboratory. The terms of
reference for all WHO GISRS laboratories have been developed under the following overarching
Guiding Principles:
Guiding Principles for the development of terms of reference for current and potential
future WHO global influenza surveillance and response system (GISRS) laboratories for
H5N1 and other human pandemic influenza viruses
1.
All activities conducted by WHO GISRS laboratories under their WHO terms of reference will
be consistent with the Framework and the Standard Material Transfer Agreement.*
2.
The WHO GISRS laboratories will be coordinated by, and provide support to, WHO.
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
114
SIXTY-FOURTH WORLD HEALTH ASSEMBLY
3.
The WHO GISRS laboratories will provide a timely summary report of laboratory analyses and
on request any other available information on tests conducted, test results and associated risk
assessment and risk response as is specified in their terms of reference.
4.
The WHO GISRS laboratories will share experience and provide capacity strengthening support
to WHO Member States within their resources where necessary.
5.
The WHO GISRS laboratories will provide support as specified in their terms of reference for
the development of potential pandemic vaccine, pandemic vaccine, diagnostic test materials and
pharmaceuticals.
6.
If WHO GISRS laboratories conduct research on influenza viruses received for public health
surveillance purposes, they will do so in a manner that includes participation of scientists, to the fullest
extent possible, from the submitting National Influenza Centre or other authorized laboratory,
especially those from developing countries, including through the publication process.
7.
The WHO GISRS laboratories will support global public health preparedness and response,
especially for urgent situations including international outbreaks and epidemics.
8.
The WHO GISRS laboratories will share in a rapid, systematic and timely manner PIP
biological materials, using the Influenza Virus Traceability Mechanism as appropriate, including
distribution to other qualified laboratories, to facilitate public health risk assessment, risk response
activities and scientific research in accordance with the Standard Material Transfer Agreement.1*
9.
The WHO GISRS laboratories will submit genetic sequences data to GISAID and Genbank or
similar databases in a timely manner consistent with the Standard Material Transfer Agreement.*
10. The originating laboratories which provide the PIP biological materials received by the WHO
GISRS laboratories will be given due credit and recognition.
Core terms of reference
WHO H5 Reference Laboratories are laboratories which are designated through a defined WHO
process, on an ad hoc basis, and which meet the core terms of reference listed below.
A.
General conditions and activities
WHO H5 Reference Laboratories:
1.
work under the coordination of the WHO Global Influenza Programme; and provide support to
WHO (Guiding Principle 2);
2.
meet the WHO criteria for accepting positive results of H5 infection in humans;1
3.
use the WHO Influenza Virus Traceability Mechanism to record the receipt and transfer of PIP
biological materials (Guiding Principle 8);
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
1
WHO web site.
ANNEX 2
115
4.
comply with the Standard Material Transfer Agreement* of the Pandemic Influenza
Preparedness Framework for sharing of influenza viruses and access to vaccines and other benefits.
(Guiding Principle 1);
5.
provide laboratory services to its own country and other countries when needed for diagnosis of
influenza A(H5) and other influenza viruses with pandemic potential (Guiding Principles 3, 7);
6.
alert WHO and the country that provided clinical specimens and/or viruses with pandemic
potential about unusual findings related to pandemic influenza risk assessment (Guiding Principles 3, 7);
7.
provide feedback to WHO on the use of WHO recommended diagnostic protocols and primers
to assist WHO in updating laboratory diagnostic recommendations (Guiding Principles 2, 3, 4, 5).
B.
Laboratory and other activities
WHO H5 Reference Laboratories:
1.
provide advice to clinics, hospitals and other specimen collection sites on safe and appropriate
clinical specimen collection, storage, packaging and shipping (Guiding Principle 7);
2.
conduct accurate laboratory diagnosis, typing and subtyping and confirmation of influenza
A(H5) and other influenza viruses with pandemic potential for specimens received and make the
results available to WHO Collaborating Centres and the originating laboratories in a timely manner
(Guiding Principles 2, 3, 4, 7);
3.
provide expertise and laboratory support in response to outbreaks of A(H5) and other influenza
viruses with pandemic potential (Guiding Principles 2, 3, 4, 5, 7);
4.
routinely share clinical specimens and/or virus isolates from A(H5) and other influenza viruses
with pandemic potential with WHO Collaborating Centres for further characterization in accordance
with the Standard Material Transfer Agreement* (Guiding Principles 1, 8, 10);
5.
share available haemagglutinin, neuraminidase and other gene sequences of A(H5) and other
influenza viruses with pandemic potential immediately with the originating laboratory, WHO
Collaborating Centres and H5 Reference Laboratories (Guiding Principle 3);
6.
upload available haemagglutinin, neuraminidase and other gene sequences of A(H5) and other
influenza viruses with pandemic potential to a publicly accessible database in a timely manner, but no
later than three months after sequencing is completed, unless otherwise instructed by the laboratory or
country providing the clinical specimens and/or viruses (Guiding Principle 9);
7.
appropriately acknowledge the originating laboratories providing clinical specimens and/or
influenza viruses with pandemic potential (Guiding Principles 8, 10).
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
116
C.
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Research, scientific presentations and publications
WHO H5 Reference Laboratories:
1.
actively seek the participation of scientists from originating laboratories/countries in scientific
projects associated with research on clinical specimens and/or influenza viruses from their countries
and actively engage them in preparation of manuscripts for presentation and publication (Guiding
Principle 6);
2.
appropriately acknowledge in presentations and publications, the contributions of collaborators,
including laboratories/countries providing clinical specimens or influenza viruses with pandemic
potential or reagents, using guidelines such as those outlined by the International Committee of
Medical Journal Editors1 (Guiding Principle 6).
1
See http://www.icmje.org/.
ANNEX 2
117
ESSENTIAL REGULATORY LABORATORIES
TERMS OF REFERENCE RELATED TO WORK WITH PANDEMIC
INFLUENZA PREPAREDNESS BIOLOGICAL MATERIALS
BACKGROUND
The WHO global influenza surveillance and response system (GISRS) serves as a global alert
mechanism for the emergence of influenza viruses with important features, including those with
pandemic potential. For activities related to pandemic influenza, the WHO GISRS includes four
complementary categories of institutions and laboratories: National Influenza Centres, WHO
Collaborating Centres, WHO H5 Reference Laboratories and Essential Regulatory Laboratories. The
WHO GISRS is coordinated by the WHO Global Influenza Programme. Within each category all
institutions and laboratories perform functions defined by core terms of reference. The core terms of
reference for Essential Regulatory Laboratories are the minimum requirements that must be met by
each Essential Regulatory Laboratory and the capacity to fulfil these is a prerequisite to designation as
an Essential Regulatory Laboratory. Each laboratory or institution that is formally recognized or
designated as a part of the WHO GISRS by WHO has accepted to be bound by the core terms of
reference applicable to its category. The following are the core terms of reference applicable to the
Essential Regulatory Laboratories.
Essential Regulatory Laboratories are formally associated with national regulatory agencies, and have
a critical role in developing, regulating and standardizing influenza vaccines. They have performed
this role for nearly four decades within the WHO GISRS, and have thereby contributed to the
production of safe and effective influenza vaccines through the selection and development of
candidate vaccine viruses. While they previously had no formal terms of reference with WHO, in
practice, they worked closely with both WHO and the influenza vaccine manufacturers. Currently
there are four Essential Regulatory Laboratories: the Center for Biologics Evaluation and Research,
United States of America; the National Institute for Biological Standards and Control, United
Kingdom of Great Britain and Northern Ireland; the National Institute for Infectious Diseases, Japan,
and the Therapeutic Goods Administration, Australia.
The core terms of reference are the minimum requirements that must be met by each Essential
Regulatory Laboratory, either individually or as a group. Specific terms of reference may be discussed
with and agreed upon by the Essential Regulatory Laboratory, the WHO Global Influenza Programme
and, in some cases, industry before recognition.
It is understood that the Guiding Principles, as agreed by the Intergovernmental Meeting and
reproduced below, will guide all activities, specific terms of reference or associated functions of the
WHO GISRS laboratories when they act in their capacity as a WHO GISRS laboratory. The terms of
reference for all WHO GISRS laboratories have been developed under the following overarching
Guiding Principles:
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Guiding Principles for the development of terms of reference for current and potential
future WHO GISRS laboratories for H5N1 and other human pandemic influenza viruses
1.
All activities conducted by WHO GISRS laboratories under their WHO terms of reference will
be consistent with the Framework and the Standard Material Transfer Agreement.*
2.
The WHO GISRS laboratories will be coordinated by, and provide support to, WHO.
3.
The WHO GISRS laboratories will provide a timely summary report of laboratory analyses and
on request any other available information on tests conducted, test results and associated risk
assessment and risk response as is specified in their terms of reference.
4.
The WHO GISRS laboratories will share experience and provide capacity strengthening support
to WHO Member States within their resources where necessary.
5.
The WHO GISRS laboratories will provide support as specified in their terms of reference for
the development of potential pandemic vaccine, pandemic vaccine, diagnostic test materials and
pharmaceuticals.
6.
If WHO GISRS laboratories conduct research on influenza viruses received for public health
surveillance purposes, they will do so in a manner that includes participation of scientists, to the fullest
extent possible, from the submitting National Influenza Centre or other authorized laboratory,
especially those from developing countries, including through the publication process.
7.
The WHO GISRS laboratories will support global public health preparedness and response,
especially for urgent situations including international outbreaks and epidemics.
8.
The WHO GISRS laboratories will share in a rapid, systematic and timely manner PIP
biological materials, using the Influenza Virus Traceability Mechanism as appropriate, including
distribution to other qualified laboratories, to facilitate public health risk assessment, risk response
activities and scientific research in accordance with the Standard Material Transfer Agreement.*
9.
The WHO GISRS laboratories will submit genetic sequences data to GISAID and Genbank or
similar databases in a timely manner consistent with the Standard Material Transfer Agreement.*
10. The originating laboratories which provide the PIP biological materials received by the WHO
GISRS laboratories will be given due credit and recognition.
Core terms of reference
Essential Regulatory Laboratories meet the following core terms of reference listed below, either
individually or as a group:
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
ANNEX 2
A.
119
General conditions and activities
Essential Regulatory Laboratories:
1.
advise WHO on the selection of H5N1 and other influenza viruses with pandemic potential for
use in influenza vaccines (Guiding Principles 2, 3, 5);
2.
assist WHO and Member States in developing vaccine-related aspects of preparedness and
response plans for pandemic influenza (Guiding Principles 2, 3, 4, 7);
3.
advise WHO on relevant regulatory and development aspects of vaccines for H5N1 and other
influenza viruses with pandemic potential (Guiding Principles 2, 3, 5);
4.
when requested, inform and advise WHO on work programmes and new technologies aimed at
improving development and standardization of vaccines for H5N1 and other influenza viruses with
pandemic potential (Guiding Principles 2, 3, 4, 5);
5.
use the WHO Influenza Virus Traceability Mechanism to record the receipt and transfer of PIP
biological materials (Guiding Principles 8);
6.
comply with the Standard Material Transfer Agreement* of the Pandemic Influenza
Preparedness Framework for sharing of influenza viruses and access to vaccines and other benefits
(Guiding Principle 1).
B.
Laboratory and related activities
Essential Regulatory Laboratories:
1.
store, and, if required, amplify representative H5N1 and other influenza viruses with pandemic
potential obtained from the WHO GISRS for the purpose of developing influenza vaccine viruses
(Guiding Principles 1, 2);
2.
on request by WHO, develop candidate H5N1 and other influenza vaccine viruses with
pandemic potential and characterize them using agreed standards (Guiding Principles 1, 2, 3, 5, 6);
3.
store, and, if required, amplify candidate H5N1 and other influenza vaccine viruses with
pandemic potential obtained from the WHO GISRS (Guiding Principles 1, 2, 3, 5);
4.
prepare and calibrate reference reagents for standardization of candidate influenza vaccine
viruses for H5N1 and other influenza viruses with pandemic potential in conjunction with other
Essential Regulatory Laboratories (Guiding Principles 1, 2, 5);
5.
distribute, subject to the Standard Material Transfer Agreement,* candidate influenza vaccine
viruses for H5N1 and other influenza viruses with pandemic potential to interested laboratories,
including laboratories within the WHO GISRS and influenza vaccine manufacturers (Guiding
Principles 1, 2, 5);
* Editor’s note: the reference to “Standard Material Transfer Agreement” is understood to mean “Standard Material
Transfer Agreement 1”.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
6.
directly or through contractors, supply reference reagents for standardization of H5N1 and other
potential pandemic influenza vaccines to laboratories, such as laboratories within the WHO GISRS,
national regulatory laboratories and influenza vaccine manufacturers (Guiding Principles 1, 2, 5);
7.
analyse, provide data and advice to WHO and participate in meetings and teleconferences
concerning the selection, development and timely availability of candidate vaccine viruses for H5N1
and other influenza viruses with pandemic potential (Guiding Principles 2, 5, 7).
C.
Research and scientific presentations and publications
Essential Regulatory Laboratories:
1.
actively seek the participation of scientists from originating laboratories/countries in scientific
projects associated with research on clinical specimens and/or influenza viruses from their countries
and actively engage them in preparation of manuscripts for presentation and publication (Guiding
Principle 6);
2.
appropriately acknowledge in presentations and publications, the contributions of collaborators,
including laboratories/countries providing clinical specimens or influenza viruses with pandemic
potential or reagents, using guidelines such as those outlined by the International Committee of
Medical Journal Editors1 (Guiding Principle 6).
_______________
1
See http://www.icmje.org/.
ANNEX 3
First Global Ministerial Conference
on Healthy Lifestyles and Noncommunicable Disease Control
Moscow, 28–29 April 2011
MOSCOW DECLARATION1
PREAMBLE
We, the participants in the First Global Ministerial Conference on Healthy Lifestyles and
Noncommunicable Disease (NCD) Control, gathered in Moscow on 28–29 April 2011.
I.
Express appreciation for the leading role of the World Health Organization and the Government of the
Russian Federation in the preparation and holding of the Ministerial Conference.
II.
Recognize that the right of everyone to the enjoyment of the highest attainable standards of physical
and mental health cannot be achieved without greater measures at global and national levels to prevent
and control NCDs.
III.
Acknowledge the existence of significant inequities in the burden of NCDs and in access to NCD
prevention and control, both between countries, as well as within countries.
IV.
Note that policies that address the behavioural, social, economic and environmental factors associated
with NCDs should be rapidly and fully implemented to ensure the most effective responses to these
diseases, while increasing the quality of life and health equity.
V.
Emphasize that prevention and control of NCDs requires leadership at all levels, and a wide range of
multi-level, multi-sectoral measures aimed at the full spectrum of NCD determinants (from individuallevel to structural) to create the necessary conditions for leading healthy lives. This includes
promoting and supporting healthy lifestyles and choices, relevant legislation and policies; preventing
and detecting disease at the earliest possible moment to minimize suffering and reduce costs; and
providing patients with the best possible integrated health care throughout the life cycle including
empowerment, rehabilitation and palliation.
1
See resolution WHA64.11.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
VI.
Recognize that a paradigm shift is imperative in dealing with NCD challenges, as NCDs are caused not
only by biomedical factors, but also caused or strongly influenced by behavioural, environmental,
social and economic factors.
VII.
Affirm our commitment to addressing the challenges posed by NCDs, including, as appropriate,
strengthened and reoriented policies and programmes that emphasize multi-sectoral action on the
behavioural, environmental, social and economic factors.
VIII.
Express our belief that NCDs should be considered in partnerships for health; that they should be
integrated into health and other sectors’ planning and programming in a coordinated manner,
particularly in low- and middle-income countries; that they should be part of the global research
agenda and that the impact and sustainability of approaches to prevent and control NCDs will be
enhanced through health systems strengthening and strategic coordination with existing global health
programs.
RATIONALE FOR ACTION
1.
NCDs, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases,
are the leading causes of preventable morbidity and disability, and currently cause over 60% of
global deaths, 80% of which occur in developing countries. By 2030, NCDs are estimated to
contribute to 75% of global deaths.
2.
In addition, other NCDs such as mental disorders also significantly contribute to the global
disease burden.
3.
NCDs have substantial negative impacts on human development and may impede progress
towards the Millennium Development Goals (MDGs).
4.
NCDs now impact significantly on all levels of health services, health care costs, and the health
workforce, as well as national productivity in both emerging and established economies.
5.
Worldwide, NCDs are important causes of premature death, striking hard among the most
vulnerable and poorest populations. Globally they impact on the lives of billions of people and
can have devastating financial impacts that impoverish individuals and their families, especially
in low- and middle-income countries.
6.
NCDs can affect women and men differently, hence prevention and control of NCDs should
take gender into account.
7.
Many countries are now facing extraordinary challenges from the double burden of disease:
communicable diseases and noncommunicable diseases. This requires adapting health systems
and health policies, and a shift from disease-centred to people-centred approaches and
population health measures. Vertical initiatives are insufficient to meet complex population
needs, so integrated solutions that engage a range of disciplines and sectors are needed.
Strengthening health systems in this way results in improved capacity to respond to a range of
diseases and conditions.
ANNEX 3
123
8.
Evidence-based and cost-effective interventions exist to prevent and control NCDs at global,
regional, national and local levels. These interventions could have profound health, social, and
economic benefits throughout the world.
9.
Examples of cost-effective interventions to reduce the risk of NCDs, which are affordable in
low-income countries and could prevent millions of premature deaths every year, include
measures to control tobacco use, reduce salt intake and reduce the harmful use of alcohol.
10.
Particular attention should be paid to the promotion of healthy diets (low consumption of
saturated fats, trans fats, salt and sugar, and high consumption of fruits and vegetables) and
physical activity in all aspects of daily living.
11.
Effective NCD prevention and control require leadership and concerted “whole of government”
action at all levels (national, sub-national and local) and across a number of sectors, such as
health, education, energy, agriculture, sports, transport and urban planning, environment, labour,
industry and trade, finance and economic development.
12.
Effective NCD prevention and control require the active and informed participation and
leadership of individuals, families and communities, civil society organizations, private sector
where appropriate, employers, health care providers and the international community.
COMMITMENT TO ACTION
We, therefore, commit to act by:
At the Whole of Government level:
1.
Developing multi-sectoral public policies that create equitable health promoting environments
that enable individuals, families and communities to make healthy choices and lead healthy
lives;
2.
Strengthening policy coherence to maximize positive and minimize negative impacts on NCD
risk factors and the burden resulting from policies of other sectors;
3.
Giving priority to NCD prevention and control according to need, ensuring complementarity
with other health objectives and mainstreaming multi-sectoral policies to strengthen the
engagement of other sectors;
4.
Engaging civil society to harness its particular capacities for NCD prevention and control;
5.
Engaging the private sector in order to strengthen its contribution to NCD prevention and
control according to international and national NCD priorities;
6.
Developing and strengthening the ability of health systems to coordinate, implement, monitor
and evaluate national and sub-national strategies and programmes on NCDs;
7.
Implementing population-wide health promotion and disease prevention strategies,
complemented by individual interventions, according to national priorities. These should be
equitable and sustainable and take into account gender, cultural and community perspectives in
order to reduce health inequities;
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8.
Implementing cost-effective policies, such as fiscal policies, regulations and other measures to
reduce common risk factors such as tobacco use, unhealthy diet, physical inactivity and the
harmful use of alcohol;
9.
Accelerating implementation by States Parties of the provisions of the WHO Framework
Convention on Tobacco Control (WHO FCTC) and encouraging other countries to ratify the
Convention;
10.
Implementing effective policies for NCD prevention and control at national and global levels,
including those relevant to achieving the goals of the 2008–2013 Action Plan for the Global
Strategy for the Prevention and Control of Noncommunicable Diseases, the WHO Global
Strategy to Reduce the Harmful Use of Alcohol and the Global Strategy on Diet, Physical
Activity and Health;
11.
Promoting recognition of the rising incidence and burden of NCDs on national as well as
international development agendas, and encouraging countries and international development
partners to consider the level of priority accorded to NCDs.
At Ministry of Health level:
1.
Strengthening health information systems to monitor the evolving burden of NCDs, their risk
factors, their determinants and the impact and effectiveness of health promotion, prevention and
control policies and other interventions;
2.
According to national priorities, strengthening public health systems at the country level to scale
up evidence-based health promotion and NCD prevention strategies and actions;
3.
Integrating NCD-related services into primary health care services through health systems
strengthening, according to capacities and priorities;
4.
Promoting access to comprehensive and cost-effective prevention, treatment and care for
integrated management of NCDs, including access to affordable, safe, effective and high quality
medicines based on needs and resource assessments;
5.
According to country-led prioritization, ensuring the scaling-up of effective, evidence-based and
cost-effective interventions that demonstrate the potential to treat individuals with NCDs,
protect those at high risk of developing them and reduce risk across populations.
6.
Promoting, translating and disseminating research to identify the causes of NCDs, effective
approaches for NCD prevention and control, and strategies appropriate to distinct cultural and
health care settings.
At the International level:
1.
Calling upon the World Health Organization, as the lead UN specialized agency for health, and
all other relevant UN system agencies, development banks, and other key international
organizations to work together in a coordinated manner to address NCDs;
2.
Working through WHO in consultation with other multilateral organizations, international
nongovernmental organizations, the private sector and civil society stakeholders to strengthen
normative guidance, pool technical expertise, coordinate policy to achieve the best possible
results and capitalize on synergies among existing global health initiatives.
ANNEX 3
125
3.
Strengthening international support for the full and effective implementation of the WHO
FCTC, the Action Plan for the Global Strategy for the Prevention and Control of
Noncommunicable Diseases, the WHO Global Strategy to Reduce the Harmful Use of Alcohol,
the Global Strategy on Diet, Physical Activity and Health and other relevant international
strategies to address NCDs.
4.
Investigating all possible means to identify and mobilize the necessary financial, human and
technical resources in ways that do not undermine other health objectives.
5.
Supporting the WHO in developing a comprehensive global monitoring framework on NCDs.
6.
Examining possible means to continue facilitating the access of low- and middle-income
countries to affordable, safe, effective and high quality medicines in this area consistent with the
WHO Model Lists of Essential Medicines, based on needs and resource assessments, including
by implementing the WHO Global Strategy and Plan of Action on Public Health, Innovation
and Intellectual Property.
WAY FORWARD
With a view to securing an ambitious and sustainable outcome, we commit to actively engaging with
all relevant sectors of Government, on the basis of this Moscow Declaration, in the preparation of and
the follow-up to the United Nations General Assembly High-level Meeting on the Prevention and
Control of Non-communicable Diseases in New York.
_______________
ANNEX 4
Global health sector strategy on HIV/AIDS, 2011–20151
[A64/15, Annex – 28 April 2011]
1.
INTRODUCTION
1.
The global health sector strategy on HIV/AIDS, 2011–2015 guides the health sector response to
human immunodeficiency virus (HIV) epidemics in order to achieve universal access to HIV
prevention, diagnosis, treatment, care and support.2 The strategy:
• reaffirms global goals and targets for the health sector response to HIV
• identifies four strategic directions to guide national responses
• outlines recommended country actions and WHO’s contributions within each strategic
direction.
2.
The strategy was elaborated in order to define the health sector’s contribution to the broader,
multisectoral response to HIV outlined in the UNAIDS strategy for 2011–2015.3 Implementation of
the strategy will be supported by the WHO Secretariat, in collaboration with UNAIDS and other
UNAIDS cosponsors. Collaboration in relevant policy and technical areas is identified, based on the
division of labour proposed by UNAIDS.
3.
The strategy promotes a long-term, sustainable HIV response through strengthening health and
community systems, tackling the social determinants of health that both drive the epidemic and hinder
the response, and protecting and promoting human rights and promoting gender equity as essential
elements of the health sector response. It strengthens integration between HIV and other health
services, improving both impact and efficiency. It calls on the world to build on the collaboration,
innovation and investment that have forged hard-won progress to date, establishing the foundation for
success over the next five years. Figure 1 depicts the elements of the strategy schematically.
1
See resolution WHA64.14.
2
The health sector encompasses organized public and private health services, health ministries, nongovernmental
organizations, community groups and professional associations, as well as institutions that directly input into the health-care
system.
3
Getting to Zero: UNAIDS Strategy 2011–2015, Geneva, UNAIDS, 2010.
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ANNEX 4
127
Figure 1 Summary of the global health sector strategy on HIV/AIDS, 2011–2015
1.1
Context and rationale
4.
The past 10 years have seen unprecedented commitments to global health and development,
beginning in 2000 with the commitments in the United Nations Millennium Declaration that became
known as the Millennium Development Goals with their corresponding set of time-bound targets. At
the 2001 United Nations General Assembly Special Session on HIV/AIDS, United Nations Member
States made pledges for a comprehensive response to HIV in the Declaration of Commitment on
HIV/AIDS, and expanded those commitments in the Political Declaration on HIV/AIDS adopted in
2006, including a commitment to achieve universal access to HIV prevention, treatment, care and
support for all in need. A rapid expansion in HIV services and dedicated AIDS financing paralleled
these developments, with commitments rising from US$ 1600 million in 2001 to US$ 15 900 million
in 2009, including substantial financing from the United States’ President’s Emergency Plan for AIDS
Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other bilateral, multilateral and
domestic sources. The results have been remarkable:
• the number of new HIV infections globally declined 19% over the past decade. In 15 high
burden countries HIV prevalence declined more than 25% among young people aged
15–24 years. These declines are largely attributable to expanded, improved HIV programmes
• access to antiretroviral therapy in low- and middle-income countries increased from only
400 000 people receiving such therapy in 2003 to 5.25 million by the end of 2009 (comprising
35% of those estimated to be in need)
• AIDS-related deaths dropped by 19% globally over the period 2004 to 2009 alone
• significant reductions in the price of first-line antiretroviral medicines mean that low-income
countries can provide a year of antiretroviral therapy at a median cost of US$ 137 per person
• 53% of pregnant women living with HIV had access to antiretroviral medicines to prevent
transmission of HIV to their infants, up from 45% in 2008.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
5.
Challenges for the global response to HIV. This progress, however, is fragile and unevenly
distributed. HIV incidence is increasing in some countries and regions, and too many new infections
are still occurring: 2.6 million in 2009 alone, contributing to the current global prevalence of
33.3 million.1 Although much reduced from their peak in 1999, new infections continue to outpace the
number of people placed on treatment. Most people in need still do not have access to antiretroviral
therapy, and demand is growing.
6.
Sub-Saharan Africa accounts for 68% of the global prevalence of HIV, with diverse,
generalized HIV epidemics that disproportionately affect women and young people (particularly
young women). Women now account for almost 52% of global adult prevalence (60% of prevalence in
sub-Saharan Africa), with gender inequity and harmful social norms helping drive transmission. This
region will require intensified efforts in HIV prevention, treatment, care and support in order to
reverse the spread of HIV and treat all those in need, with a stronger focus on the needs of women,
girls and other vulnerable populations.2 Even though young people (aged 15–24 years) are making
important contributions to reducing HIV incidence, their access to priority HIV interventions,
including sexual and reproductive health services and education during formative adolescent years,
varies widely among countries.
7.
HIV infection rates are increasing in several countries in eastern Europe and central Asia, which
have expanding, concentrated epidemics, notably among people who inject drugs and their sexual
networks.
8.
National HIV responses are too often poorly targeted to the national epidemiological situation,
and the HIV interventions delivered in many settings are of poor quality and do not adequately focus
on vulnerable and most-at-risk populations3 in both generalized and concentrated epidemic settings.
Although variations in prevalence and epidemiological patterns within countries and regions require
different priorities and interventions, all national HIV plans should incorporate service delivery to
these populations in order to ensure the effectiveness of national HIV responses. In addition those
national plans need to incorporate measures to overcome structural barriers that undermine access to
quality services.4
9.
WHO’s advocacy will emphasize the additional health sector investments required to achieve
the Millennium Development Goals and targets and the goal of universal access. Although the current
global economic climate is threatening both domestic and overseas development assistance, new
directions and opportunities for attaining universal access are emerging: combination prevention; the
Treatment 2.0 platform; eliminating new HIV infections among children; and the emerging scientific
and programmatic evidence guiding the development of new, more effective approaches to HIV.
The 2011 United Nations General Assembly High Level Meeting on AIDS (scheduled to be held in
New York, 8–10 June 2011) will review progress made towards achieving global HIV goals and
targets and will chart the future course of the HIV response. The strategy outlines the health sector
1
Global report: UNAIDS report on the global AIDS epidemic 2010. Geneva, UNAIDS, 2010.
2
Vulnerability to HIV is defined within the strategy as the extent to which individuals or specific populations are able
to control their risk of acquiring HIV, such as agency in sexual decision-making, lack of knowledge about HIV, lack of
access to male or female condoms, and other factors that affect HIV transmission.
3
Most-at-risk populations are defined within the strategy as men who have sex with men, transgender people, people
who inject drugs, sex workers and prisoners.
4
Structural barriers are systemic barriers (social, cultural and legal) to access faced by key populations that deter
them from accessing HIV services and reduce the effectiveness of services. Example of such structural barriers are police
harassment and violence towards certain populations, and discriminatory policies, practices and attitudes in health services.
Structural interventions aim to remove these barriers.
ANNEX 4
129
contribution to this response and is designed to be sufficiently flexible to incorporate decisions from
that meeting.
10. The need for coordinated health sector action on HIV. Evidence and experience to date
provide a compelling rationale for a new global health sector strategy on HIV. The WHO strategy is
designed to meet the complex challenges of a dynamic epidemic in a rapidly evolving stage of global
health actors. WHO’s work on HIV has been guided by a series of broad-based strategies and
initiatives, including the Global health-sector strategy on HIV/AIDS 2003–2007, the “3 by 5”
initiative, and the WHO 2006–2010 plan for universal access. The evaluation of and experience from
this work highlight the value of a strong WHO presence – and guiding framework – in supporting
national efforts and building on progress made. This strategy builds on that work, outlining a robust,
evidence-based guide for the health sector response to HIV from 2011 to 2015.
1.2
Contribution to the UNAIDS strategy for 2011–2015 and global health sector
strategies
11. Ensuring alignment and coordination with the UNAIDS strategy for 2011–2015, Getting to
Zero, is a cornerstone of WHO’s strategy. The UNAIDS strategy provides the multisectoral
framework for the response of the 10 cosponsors and secretariat to the HIV pandemic. Although the
health sector is central to the HIV response, it must collaborate with other sectors in order to tackle the
social, economic, cultural and environmental issues that shape the epidemic and access to health
services. The WHO strategy outlines core components of WHO’s contribution to UNAIDS’ three
strategic directions, namely:
• revolutionize HIV prevention (see Section 3.1 and 3.2)
• catalyse the next phase of treatment, care and support (see Section 3.3 and 3.4)
• advance human rights and gender equality for the HIV response (see Section 6.1 and 6.2).
12. In addition to setting the agenda for HIV programmes the WHO strategy aims to maximize the
synergies between HIV and other health programmes in order to achieve the health-related Millennium
Development Goals. It is closely aligned with other global health strategies and plans, including those
for tuberculosis, reproductive health, sexually transmitted infections, maternal, newborn and child
health, and public health and innovation (see Appendix); it also contributes to broader public health
and development priorities, including health system strengthening and the social determinants of
health. Recent progress indicates that universal access is achievable in a range of epidemiological and
resource contexts. Continuing the momentum towards this goal is imperative, and the health sector has
a central role in achieving success in the global response to HIV.
2.
GLOBAL VISION, GOALS, TARGETS AND STRATEGIC DIRECTIONS
2.1
Global vision
13. Zero new HIV infections, zero AIDS-related deaths and zero discrimination in a world where
people living with HIV are able to live long, healthy lives.
2.2
Global goals and targets
14.
The two overarching goals of the strategy are:
• to achieve universal access to comprehensive HIV prevention, treatment and care
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• to contribute to achieving Millennium Development Goal 6 (Combat HIV/AIDS, malaria and
other diseases) and other health-related Goals (3, 4, 5 and 8) and associated targets.
15.
The four targets for 2015, aimed at accelerating progress towards the strategy’s goals, are:
• reduce new infections: reduce by 50% the percentage of young people aged 15–24 years
who are infected (compared with a 2009 baseline)
• eliminate new HIV infections in children: reduce new HIV infections in children by 90%
(compared with a 2009 baseline)
• reduce HIV-related mortality: reduce HIV-related deaths by 25% (compared with a 2009
baseline)
• reduce tuberculosis-related mortality: reduce tuberculosis deaths by 50% (compared with a
2004 baseline).
2.3
Strategic directions
16. The health sector response to HIV should follow four mutually-supportive strategic directions,
outlined below with their objectives. These are aimed at achieving the above targets and goals over the
five years of the strategy. Each content area is subdivided into recommended country action and
WHO’s contribution to support that action.
17. Strategic direction 1: Optimize HIV prevention, diagnosis, treatment and care
outcomes. Integrate and improve the quality, effectiveness and coverage of HIV-specific interventions
and approaches, and identify new HIV interventions as evidence emerges.
18. Strategic direction 2: Leverage broader health outcomes through HIV responses.
Strengthen linkages and synergies between HIV and other related health programmes, notably for
sexual and reproductive health, maternal, newborn and child health, tuberculosis, drug dependence and
harm reduction, emergency and surgical care and nutrition.
19. Strategic direction 3: Build strong and sustainable systems. Build effective, efficient and
comprehensive health systems in which HIV and other essential services are available, accessible,
affordable and sustainable.
20. Strategic direction 4: Reduce vulnerability and remove structural barriers to accessing
services. The health sector must reduce risk and vulnerability by removing structural barriers to
achieving equitable access to HIV services and protecting and promoting the human rights of key
populations.1
21. These four strategic directions are elaborated in detail in the following sections. Their
relationship to each other is depicted in Figure 2. They are designed to collectively achieve the shared
vision and goals of both the WHO and UNAIDS strategies on HIV/AIDS for 2011–2015.
1
Key populations are defined within the strategy to include both vulnerable and most-at-risk populations. They are
important to the dynamics of HIV transmission in a given setting and are essential partners in an effective response to the
epidemic.
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Figure 2 Relationship between the four strategic directions
2.4
“Know your epidemic, know your response”
22. “Know your epidemic”. Given the widely differing characteristics of the epidemics between
countries and regions, national responses must be guided by the most current strategic information on
the nature of the HIV epidemic and the country context. Knowing the epidemic thus includes
understanding where, how and among whom new infections are occurring. It also requires identifying
the social, legal and economic conditions that increase the risk of HIV transmission and limit access to
HIV information and services. National responses must take into consideration:
• the preparedness, infrastructure and capacity of the health system or health systems
• whether the current response meets the needs of those most vulnerable to and at risk of HIV
infection
• community and stakeholders’ contributions
• how to reach marginalized and remote populations and provide services in settings of
humanitarian concern.
23. Even though surveillance systems have improved considerably since the start of the epidemic, it
is clear that many countries still have weak health-information systems. Epidemiological information
on populations at highest risk of HIV infection (for example, men who have sex with men, transgender
people, sex workers, prisoners and people who inject drugs) is often limited or of poor quality. This
problem is compounded by the absence of strong national health-information and vital-registration
systems. Building stronger data collection systems for HIV surveillance and other health information
is essential to understanding the epidemic and informing national HIV responses. Ensuring civil
society’s participation in the development and implementation of these systems is crucial for ensuring
that data gathering and analysis are robust and ethical.
24. “Know your response”. The national health sector response to HIV should be guided by a
national strategic planning process that reviews, plans and prioritizes specific interventions and service
delivery models that best meet national health needs. HIV programme information (including
monitoring and evaluation data) must be linked to broader health-information systems in order to
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ensure that robust, current and accurate information is gathered on national responses to HIV,
including the populations accessing services, how services are delivered (for instance, through health
facilities, community-based services or other delivery models) and HIV intervention availability and
coverage for vulnerable and at-risk populations. WHO, UNICEF and UNAIDS have developed
standardized tools to support country-level data collection, which is vital for establishing accurate
information on national AIDS responses and global level reporting.
3.
STRATEGIC DIRECTION 1: OPTIMIZE HIV PREVENTION, DIAGNOSIS,
TREATMENT AND CARE OUTCOMES
25. Expanding coverage and improving the quality of HIV prevention, diagnosis, treatment and care
interventions are required to achieve global goals and targets. HIV incidence is falling in many
countries, but is increasing in others. National HIV responses must target high-quality, evidence-based
HIV-specific prevention interventions to where transmission is actually occurring, and focus efforts on
key populations underserved by current HIV programmes. Section 3.1 below on the prevention
revolution outlines how the health sector can capitalize on recent advances in reducing infections
through combining and targeting preventive interventions for maximum impact. Improved integration
of HIV and non-HIV health services, radical decentralization of service delivery, and improvements in
medicines, diagnostics and other components of HIV treatment and care will also be crucial for
accelerating progress towards national and global targets.
26. Recent population-based health surveys suggest that less than 40% of people living with HIV
know their HIV status. Providing accessible, quality-assured testing, counselling and referral services
to relevant populations and removing HIV-related stigmatization and discrimination are essential for
improving knowledge of serostatus.1 Strategic direction 1 has four core elements:
• revolutionize HIV prevention
• eliminate HIV infections in children
• catalyse the next phase of diagnosis, treatment, care and support
• provide comprehensive, integrated services for key populations.
3.1
Revolutionize HIV prevention
27. Combining behavioural, biomedical and structural HIV preventive interventions, tailored to
national epidemics, is the most effective approach to reducing new infections and improving service
coverage among key populations. Such combined interventions tackle both behavioural and social
drivers of the epidemics. Despite evidence of the effectiveness of this approach, few countries have
extensively scaled up combined interventions. Combined approaches, such as behavioural change
counselling (including that for couples), access to antiretroviral therapy and removing structural
barriers to health services (such as stigmatization and discrimination), must be expanded more broadly
and consistently.
1
Testing and counselling must be voluntary, confidential and ensure that the human rights of clients are protected and
promoted, regardless of setting or testing modality.
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133
3.1.1 Recommended country action
28. Prevent sexual transmission of HIV. Interventions to reduce sexual transmission include
behaviour change counselling, male and female condom programming, early initiation of antiretroviral
therapy, safe male circumcision (in high HIV-prevalence settings), post-exposure prophylaxis, and
quality-assured HIV testing and counselling of serodiscordant couples. Specific combination
prevention packages for key populations are outlined in Section 3.3.
29. Eliminate HIV transmission in health-care settings. Health services should implement
comprehensive infection-control strategies and procedures, including standard precautions, injection
and surgical safety, blood safety, safe waste disposal and post-exposure prophylaxis for occupational
exposure to HIV.
3.1.2 WHO’s contribution
30. Expand existing HIV prevention interventions. WHO will develop an evidence-based HIV
prevention package for the health sector and support its implementation at the national level. The
design of the prevention package will reflect the findings of a review of behavioural interventions and
advice on how they can best be combined with other interventions in a range of health settings. WHO
will provide guidance on delivering combined prevention activities in generalized epidemics,
including optimal approaches for key populations, such as women, girls and young people. It will also
advocate the application of existing guidance in concentrated epidemics and update normative
guidance as new evidence emerges.
31. Drive the development of new HIV prevention interventions and approaches. WHO will
support the evaluation of potentially effective new interventions and approaches, including
microbicides, pre-exposure prophylaxis and antiretroviral therapy as prevention, and provide guidance
to countries on implementation as results become available. WHO will continue to support HIV
vaccine development efforts through the WHO/UNAIDS HIV Vaccine Initiative. WHO will formulate
guidance and associated operational advice on preventing HIV transmission in serodiscordant couples.
3.2
Eliminate new HIV infections in children
32. The number of HIV infections among children has fallen significantly as a result of expanded
programmes to prevent mother-to-child transmission of HIV, from 500 000 in 2001 to 370 000 in
2009. As a result UNAIDS has called for the virtual elimination of new HIV infections in children by
2015, a feasible goal if comprehensive programmes to prevent such transmission are expanded and
integrated with maternal, newborn and child health, sexual and reproductive health, and other health
services, such as HIV treatment and care programmes.
3.2.1. Recommended country action
33. Eliminate new HIV infections in children. Expand comprehensive approaches to preventing
mother-to-child transmission of HIV, including setting national targets to eliminate HIV in children
using national prevention and treatment protocols. Key components include preventing HIV infection
in women of child-bearing age, preventing unintended pregnancies among women living with HIV,
reducing HIV transmission from women living with HIV to their infants, and providing appropriate
early treatment and care for women living with HIV, their children and families.
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3.2.2. WHO’s contribution
34. Work jointly with UNICEF to support eliminating new HIV infections in children. This
collaboration includes support for the United Nations Secretary-General’s Global Strategy for
Women’s and Children’s Health, and realizing WHO’s strategic vision for prevention of mother-tochild transmission of HIV. WHO and UNICEF will provide technical guidance and support for the
rapid expansion of integrated and comprehensive services for prevention of mother-to-child
transmission of HIV and will monitor progress towards achieving a world free of new HIV infections
in children. Core activities include:
• promoting provider-initiated HIV testing and counselling, re-testing, and counselling of
couples in antenatal, maternal, newborn and child health services
• supporting the implementation and evaluation of WHO’s guidelines issued in 2010 on: the
use of antiretroviral medicines to treat pregnant women; the use of antiretroviral medicines to
prevent HIV infection in infants; and HIV and infant feeding
• conducting evidence-based reviews to determine whether this guidance needs updating
• supporting an operational research agenda to guide more effective and efficient
implementation of comprehensive programmes to eliminate new HIV infections in children.
3.3
Catalyse the next phase of HIV diagnosis, treatment, care and support
35. Global declines in HIV-related morbidity and mortality reflect the enormous progress made in
HIV services over the past decade. Nevertheless, HIV prevalence and the demand on HIV diagnosis,
treatment and care services continue to increase. Given the resource-constrained environment it will be
more important than ever to select the appropriate interventions and service-delivery approach. Clientinitiated and provider-initiated testing and counselling programmes that are quality assured must be
extended in order to enable people to know their serostatus and to direct individuals to relevant
prevention, care, treatment and support services.
36. Treatment 2.0 is the initiative launched by UNAIDS and WHO in order to catalyse the second
phase of care and treatment scale-up. It aims to simplify high-quality treatment and improve the
efficiency and effectiveness of treatment and care delivery, transforming the response of programmes
from an emergency phase to long-term sustainability. WHO coordinates the work on HIV treatment
and care and HIV/tuberculosis among UNAIDS’ cosponsors, and will work with UNAIDS and global
and country partners to implement the initiative.
3.3.1. Recommended country action
37. Rapidly expand access to diversified HIV testing and counselling services. HIV testing must
be voluntary, confidential and accompanied by appropriate counselling, whether initiated by the client
or the provider. Accelerated uptake of rights-based testing and counselling services for adults and
children is required for prevention and early diagnosis and referral (as required) to care and treatment
programmes and to support safe disclosure of HIV status. Tailoring counselling and testing services
for specific populations at high risk of HIV infection may be needed in order to improve uptake and
ensure retention in care.
38. Expand and optimize HIV treatment and care for children, adolescents and adults. Countries
should update their national HIV treatment protocols on the basis of global guidelines and prepare
implementation plans in order to ensure continuity of treatment between old and new treatment
ANNEX 4
135
regimens. Antiretroviral therapy should be started early (for everyone with CD4+ cell counts of
≤350/mm3) so as to reduce HIV-related morbidity and mortality and maximize the preventive impact
on HIV and tuberculosis epidemics. Treatment should include the simplest, most tolerable and robust
drug regimens recommended by WHO guidelines and simplified point-of-care and laboratory-based
diagnostics and monitoring tools being developed through the Treatment 2.0 initiative. Nutritional care
and support should be provided to enhance treatment effectiveness and adherence, retention in care
and quality of life.
39. Reduce coinfections and co-morbidities among people living with HIV. Treatment and care
programmes should include prophylaxis (including immunization), diagnosis and treatment of
common opportunistic infections and co-morbidities. Particularly important is diagnosis and treatment
of pneumonia, diarrhoea, malaria, viral hepatitis, malnutrition and other clinical conditions that are
more serious for people living with HIV. HIV services should also screen for common malignancies,
and assess, prevent and manage mental disorders. Attention should be given to addressing the needs of
people living with HIV over the age of 50 years.
40. Decrease the burden of tuberculosis for people living with HIV. Countries should integrate
“the Three I’s” into services for people living with HIV, namely: intensified case finding for active
tuberculosis in people living with HIV; isoniazid preventive therapy in individuals with latent
tuberculosis to prevent progression to active disease; and infection control in order to minimize
transmission of tuberculosis.
41. Provide comprehensive care and support for people living with HIV. HIV-related palliative,
community and home-based care should include a multidisciplinary approach to identify, assess and
treat pain and meet other physical, psychosocial and spiritual needs of people living with HIV.
Provision of opioid medicines, and training in their use, should be available in health facilities and in
the community in order to manage pain and provide appropriate end-of-life care. Strengthening
community-care systems, including the capacity of community and home-based carers, is essential for
the delivery of integrated, decentralized services, expanding national HIV responses and improving
health outcomes.
42. Make all components of “Positive health, dignity and prevention” available to people living
with HIV. This resource1 is designed to meet the specific health needs of people living with HIV.
These include equitable access to clean water, sanitation and a full range of rights-based health
promotion and health-care services, including sexual and reproductive health and HIV prevention
counselling.
3.3.2. WHO’s contribution
43. Support improved uptake of HIV testing and counselling and linkages to care. WHO will
assess the effectiveness of various HIV testing and counselling models and provide guidance on:
• training health-care workers to expand the delivery of diverse, rights-based HIV testing and
counselling services, with a focus on improving linkages to other HIV services
• HIV testing and counselling of couples in order to reduce HIV transmission among
serodiscordant couples
1
UNAIDS, Global Network of People Living with HIV. Positive health, dignity and prevention. Technical
consultation report, 27–28 April 2009, Hammamet, Tunisia. Amsterdam, The Netherlands, The Global Network of People
Living with HIV (GNP+), 2009.
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• the application of updated HIV testing algorithms and recommendations for selecting and
using HIV diagnostics
• setting targets and improving the quality and coverage of HIV testing and counselling
services.
44. Support expanded, optimized diagnosis, treatment and care through Treatment 2.0. WHO will
support the implementation and monitoring of the Treatment 2.0 initiative, which includes the
following five core areas of work:
• optimizing treatment regimens (including fixed-dose combinations, paediatric formulations
and co-packaging of first- and second-line antiretroviral medicines)
• developing and making available standardized, quality-assured diagnostic and monitoring
tools for use at the point of care
• delivering radically decentralized, integrated HIV services
• reducing costs
• mobilizing communities in the design and implementation of diagnosis, treatment and care
programmes.
45. WHO will collaborate with UNAIDS to coordinate and monitor progress of the Treatment 2.0
initiative with global and country partners as the next phase of support to national HIV programmes.
In addition to HIV diagnostics, Treatment 2.0 will include evaluating a package of affordable,
accessible tuberculosis and viral hepatitis diagnostics for use in a range of health-care settings.
46. Pharmacovigilance will be incorporated as a standard of care into antiretroviral therapy
programmes, along with standardized tools for monitoring and preventing drug resistance. WHO will
also develop guidance on the choice of technology, their suitability in resource-constrained settings,
and quality-control mechanisms.
47. Provide guidance and tools for diagnosis, treatment and care for children with HIV. WHO
will provide guidance on early diagnosis of HIV infection in infants and rapid access to care and
treatment, including nutritional support, of HIV-exposed infants, children and adolescents, focusing on
provider-initiated testing and counselling in clinical settings. Guidance will be also be developed on
ways to improve the quality of service delivery for children in order to ensure retention in care.
48. Strengthen tools to prevent and manage HIV/tuberculosis coinfection. WHO will promote
expanded integration between HIV and tuberculosis services through the 12-point Interim policy on
collaborative TB/HIV activities.1 Key actions include:
• producing clinical guidelines and supporting implementation of operational tools for
tuberculosis prevention and treatment within HIV health services, including application of
“the Three I’s”
• promoting co-packaging, co-formulation and use of isoniazid/trimethoprim-sulfamethoxazole
combinations to prevent tuberculosis in people living with HIV
1
Document WHO/HTM/TB/2004.330.
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137
• leading the development of a robust research agenda on HIV/tuberculosis coinfection,
including improved surveillance of HIV and tuberculosis
• supporting joint reviews of HIV/tuberculosis planning and programmes.
49. Prevent, diagnose and manage other HIV-related coinfections and co-morbidities. WHO will
develop new clinical guidelines to prevent, diagnose and manage the most serious HIV-related
coinfections and co-morbidities in adults and children, including chronic viral hepatitis. WHO will
promote non-discriminatory access to diagnostic and treatment services for hepatitis B and C, and
advocate hepatitis B vaccination.
3.4
Provide comprehensive, integrated services for key populations
50. Recent country progress reports on key populations vulnerable to and at high risk of HIV
infection indicate that many of these populations still have poor access to a comprehensive set of
evidence-based HIV interventions, resulting in continued transmission of HIV. The available data
from 2009 reveal that:
• young people (aged 15–24 years) account for 40% of new adult infections and need better,
more consistent access to prevention, diagnosis and treatment services
• among young people living with HIV, about 80% live in sub-Saharan Africa and about
two-thirds are female
• coverage of harm-reduction programmes is limited; out of 92 reporting countries, only
36 countries had needle and syringe programmes and 33 offered opiod substitution therapy
• a median of 57% of men who have sex with men were reached with prevention programmes,
out of 21 reporting countries
• a median of 58% of sex workers had access to HIV prevention programmes, out of
38 reporting countries.
51. Expanding access to key populations will need integrating HIV services with other relevant
health and social services, overcoming structural barriers to service access, such as stigmatization,
discrimination and intimate partner violence, and tailoring HIV services to the needs of these
populations.
3.4.1 Recommended country action
52. Implement a comprehensive package of interventions to meet the needs of vulnerable
populations. Each country should identify populations vulnerable to HIV or underserved by current
HIV programmes in both generalized and concentrated epidemics. The needs of young people and
women should explicitly be addressed in national HIV responses. Particular attention should be given
to expanding comprehensive combination HIV prevention programmes in communities with
generalized epidemics. Policy-makers and programme managers should also consider the needs of
migrant workers, refugees or displaced populations, street children, indigenous people, disabled
people, prisoners, most-at-risk youth and people older than 50 years of age. Considerations of how
best to deliver HIV interventions to these populations include cost, venue location and operating
schedule, service-delivery methods and the structural interventions needed to reduce vulnerability.
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53. Ensure access to comprehensive services for sex workers, men who have sex with men and
transgender people. National HIV strategies, policies and programmes should meet the needs of sex
workers, men who have sex with men and transgender people in both generalized and concentrated
epidemics, including strategies to reduce stigmatization and discrimination in health-care settings and
improve access to health services. Community-based organizations and peer networks should be
involved in the planning and delivery of these services to improve the quality and effectiveness of HIV
services.
54. Provide harm-reduction services for people who use drugs. National HIV strategies, policies
and programmes in both concentrated and generalized epidemics should meet the needs of people who
use drugs. A comprehensive package of services should be provided that – in addition to tailored HIV
prevention, treatment and care interventions – includes: needle and syringe programmes; opioid
substitution therapy and other drug-dependence treatment; prevention and treatment of sexually
transmitted infections; condom programming; diagnosis and treatment of viral hepatitis and
tuberculosis; and structural interventions to improve access to services.1
55. Reduce HIV risk and vulnerability in settings of humanitarian concern. Contingency plans
for essential HIV services should be part of national HIV plans in order to ensure continuity of HIV
treatment and care in settings of humanitarian concern, including buffer stocks of essential medicines
and commodities (including antiretroviral medicines, condoms, diagnostic assays, opioid analgesics
and sterile injecting supplies). Training should be provided to essential emergency and health-service
staff, based on the Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency
Settings’s Guidelines for HIV/AIDS interventions. Policies and interventions for reducing HIV-related
stigmatization and discrimination within humanitarian health-care services should be implemented.
3.4.2 WHO’s contribution
56. Develop and promote combination prevention packages for key populations. WHO will define
health sector combination HIV prevention packages for key populations in different epidemic types
and settings. WHO will collaborate with UNESCO, UNICEF and UNFPA to design a package for
HIV prevention among young people. WHO will advocate evidence-based education on sex and
sexuality for adolescents and their access to sexual and reproductive health services. It will collaborate
with the United Nations Office on Drugs and Crime in elaborating a comprehensive health-sector
package for prisoners and prison settings and, with UNHCR on implementing interventions in the
Minimum Initial Service Package for Reproductive Health in Crisis Situations.
57. Support expansion of services for sex workers and men who have sex with men. WHO will
work with UNDP and UNFPA and members of these at-risk populations to implement its guidance on
intervention packages for sex workers, men who have sex with men and transgender people. Service
packages will include promotion of male and female condoms, behavioural change interventions,
diagnosis and treatment of sexually transmitted infections and HIV care and treatment. WHO will
provide guidance to countries on setting targets for services tailored to these populations.
58. Promote a comprehensive harm-reduction package for people who use drugs. WHO, in
collaboration with the United Nations Office on Drugs and Crime, will continue to support
implementation of evidence-based harm-reduction interventions for people who inject drugs
(including the needs of women who use drugs), and identify interventions and approaches for:
1
WHO/UNODC/UNAIDS technical guide for countries to set targets for universal access to HIV prevention,
treatment and care for injecting drug users, 2009.
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139
• effectively preventing HIV infection in people who use amphetamine-type stimulants and
cocaine and in non-injecting drug users
• reducing risk behaviours associated with alcohol use
• preventing and managing overdose.
4.
STRATEGIC DIRECTION 2: LEVERAGE BROADER HEALTH OUTCOMES
THROUGH HIV RESPONSES
59. Optimizing programme links between HIV and other key health areas is crucial for leveraging
broader health outcomes. Such links are also important to ensure that HIV responses benefit from
investments in other related health areas. HIV infection accounts for 6% of maternal mortality
worldwide, with a recent study indicating that that figure may be as high as 18%. Globally, less than a
third of children under 15 years of age in need are receiving antiretroviral therapy, reflecting a lack of
integration between HIV services and maternal, newborn and child health services. HIV is closely
linked with a wide range of other health issues, such as sexually transmitted infections, broader sexual
and reproductive health, drug dependence, tuberculosis and blood safety. These links must be reflected
in the delivery of health services in order to optimize investments in a range of health areas.
60. Early diagnosis and treatment of HIV in tuberculosis patients are compromised by low rates of
HIV testing and counselling in tuberculosis services; in 2009, only 26% of notified tuberculosis cases
knew their HIV status. Increasing numbers of drug users living with HIV are receiving antiretroviral
therapy but dying of complications from hepatitis C or of drug overdoses. Young people must have
access to education on sex and sexuality to ensure they have comprehensive, correct knowledge about
HIV; currently it remains low. The safety of the blood supply remains a significant concern; only 48%
of blood donations in low-income countries underwent quality-assured screening in 2009. HIV
transmission in health-care settings will remain a major risk without adequate investment in bloodscreening services, injection and surgical safety and other occupational health measures.
4.1
Strengthen links between HIV programmes and other health areas
61. Linking programmes and integrating HIV into other health services have the potential to
improve the efficiency and effectiveness of both HIV-specific and broader health investments:
expanded coverage of good antenatal care services supports efforts to reduce mother-to-child
transmission of HIV, and effective HIV programmes reduce tuberculosis incidence and mortality.
62. Collaboration between HIV and other health programmes should facilitate programme
coordination and align programme targets, ensure coherence across guidelines, and coordinate referral
between services and managing human resources. Major health-system components should be aligned,
including procurement and supply-management systems, laboratory services, and monitoring and
evaluation.
4.1.1. Recommended country action
63. Strengthen HIV/tuberculosis collaborative activities. Countries should implement mechanisms
for intensified collaboration and joint planning between HIV and tuberculosis programmes (outlined in
Section 3.3). Joint policies, training programmes and standard operating procedures should be
developed and put in place in order to prevent and manage HIV/tuberculosis coinfection. Surveillance
of HIV infection among tuberculosis patients and tuberculosis prevalence among people living with
HIV should be conducted, and monitoring and evaluation systems should be harmonized. Qualityassured HIV testing and counselling should be conducted among tuberculosis patients, and HIV
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prophylaxis provided to presumptive tuberculosis cases as well as tuberculosis patients. Trimethoprimsulfamethoxazole prophylaxis and antiretroviral therapy should be provided for tuberculosis patients
living with HIV.
64. Strengthen linkages between HIV and maternal, newborn and child health services. HIV
services should be integrated within a package of core interventions for maternal, newborn and child
health that includes: high-quality antenatal, perinatal and postnatal services; prevention, screening and
care for malaria and tuberculosis; syphilis screening and care; skilled birth attendance backed by
emergency obstetric care; and newborn and child care, infant feeding support, immunization and
family-centred nutritional care and support. HIV diagnostic and care services should be promoted for
children within integrated packages such as WHO’s Integrated Management of Childhood Illness.
65. Address sexual and reproductive health and rights. HIV prevention, testing and counselling
services should be integrated into sexual and reproductive health services. Access to sexual and
reproductive health services is essential for preventing unwanted pregnancies, primary HIV prevention
and preventing HIV infections in children. Health services must pay particular attention to key
populations and people living with HIV, including particular services for: prevention, diagnosis and
treatment of sexually transmitted infections; family planning, including condom programming for dual
protection and post-abortion care; cervical cancer screening and care; and survivors of sexual assault
and gender-based violence, including emergency contraception, counselling and post-exposure
prophylaxis. HIV-specific services should promote and deliver, as appropriate, family planning and
broader sexual and reproductive health services, including the sexual and reproductive rights of people
living with HIV.1
66. Integrate HIV interventions into drug use prevention, treatment and control programmes.
The nature, scope and consequences of drug use in the community should be assessed in order to guide
the development and implementation of health services tailored for people who use drugs. A
comprehensive package of harm-reduction services (see Strategic direction 1) should be integrated
into drug prevention, treatment, rehabilitation, detoxification and control programmes, whether they
be delivered by the health sector and by other sectors.
67. Strengthen the management of both HIV and noncommunicable and chronic diseases.
Lessons learnt from HIV programme expansion should be applied in order to strengthen models of
managing noncommunicable diseases, for example: mobilizing affected populations and the broader
community in advocacy and service delivery; promoting multisectoral approaches to disease
prevention, diagnosis and treatment; and decentralizing services. Noncommunicable disease
programmes should cover common health complications of people living with HIV, including
conditions associated with ageing, oral health, poor nutrition and sanitation, mental health disorders
and long-term antiretroviral therapy. Access to potable water, sanitation and hygiene facilities are vital
to the health of people living with HIV. Links between HIV and cancer programmes and services
should be strengthened.
68. Link HIV and blood and injection safety programmes. Comprehensive programmes should be
implemented to prevent HIV transmission in health-care settings. Programmes should promote
improved blood and organ-donor selection, blood and tissue screening, voluntary non-remunerated
blood donation, the rational use of blood and surgical procedures, and the implementation of safe
injection practices. Counselling for blood donors and their families should be provided as an entry
1
Sexual and reproductive health rights for people living with HIV are an essential component of Positive Health,
Dignity and Prevention.
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141
point for the treatment and care of donors who test positive for infections, thus minimizing further
transmission. Safe blood transfusion for HIV-positive individuals should be ensured.
4.1.2. WHO’s contribution
69. Support strengthened collaboration between HIV and tuberculosis programmes. WHO will
advocate for more collaboration between HIV and tuberculosis programmes and the provision of
integrated HIV and tuberculosis services. WHO will support implementation in countries of the
12 points of the Interim policy on collaborative TB/HIV activities with new or updated operational
and clinical tools to guide management of tuberculosis and HIV coinfection. Guidance will be
provided on the joint management of tuberculosis and HIV for specific populations and settings,
including links with harm reduction and prison health programmes. WHO will support national
HIV/tuberculosis programme reviews.
70. Support the integration of HIV services with those for maternal, newborn and child health
and sexual and reproductive health. WHO will promote stronger linkages between HIV programmes
and services and those for sexual and reproductive health and maternal and child health (including
those outlined in Section 3.1.1), and develop (or update) the necessary guidance and tools. WHO will
also develop and promote standardized and simplified operational tools for supporting decentralization
and integration of these services at the primary care level, including community-based services.1 WHO
will support countries in assessing their policies, systems, and service delivery approaches related to
integrating sexual and reproductive health and HIV, reviewing findings and drafting plans to
strengthen these linkages and integrate them into national health and development plans.
71. Support linkages between HIV programmes and services and those for drug control. WHO
will work closely with the United Nations Office on Drugs and Crime to strengthen collaboration
between HIV programmes and those on drug dependence and drug control. Using public health
evidence, WHO will advocate a rights-based approach to HIV prevention, diagnosis, treatment and
care within drug prevention, treatment, rehabilitation and control programmes. HIV issues will be
integrated into WHO’s normative guidance and operational tools on preventing and managing drug
dependence, as well as its guidance on the management of other health issues among people who use
drugs, such as tuberculosis, mental health, viral hepatitis, sexually transmitted infections, overdose
prevention, and maternal and child health.
72. Promote linkages between HIV programmes and other priority health programmes. WHO
will advocate strengthening the links between HIV programmes and other priority health programmes
relevant to HIV responses, including mental health, blood transfusion, emergency and surgical care,
occupational health, water sanitation, cancer control and other noncommunicable diseases.
5.
STRATEGIC DIRECTION 3: BUILD STRONG AND SUSTAINABLE SYSTEMS
73. HIV programmes have helped to strengthen national health systems by attracting new financing
for health, building health system capacity (e.g. through improved monitoring and surveillance) and
integrating chronic disease management in many resource-limited settings. However, more must be
done to ensure that HIV-related investments translate into broad-based health systems and
strengthening of community systems. An expanded HIV response must accelerate progress on
building effective, efficient and comprehensive health systems in which HIV and other essential
services are available, accessible and affordable, within which the increasingly vital role of community
1
These tools include those for the Integrated Management of Pregnancy and Childbirth and Integrated Management
of Childhood Illness.
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based services is recognized and supported. Recent evidence demonstrates the consequences of weak
health systems:
• 38% of low- and middle-income countries experienced stock-outs of antiretroviral medicines
in health facilities at least once in 2009, highlighting weak procurement and supply
management systems
• access to affordable HIV-related medicines may be hampered by failure to use the flexibilities
built into the World Trade Organization Agreement on Trade-Related Aspects of Intellectual
Property Rights (TRIPS Agreement), limited availability of some generic medicines and
formulations, weak price negotiation capacity in procurement systems, and high duties and
taxes
• task-shifting approaches have helped to reduce the shortage of health workers in many
countries, but ensuring quality, safety and motivation of those workers remains a challenge
• introducing new regimens for antiretroviral therapy, together with the need to monitor HIV
drug resistance and toxicity, places additional demands on clinical and laboratory services.
5.1
Strengthen the six building blocks of health systems
74.
National HIV responses can further strengthen the six building blocks of health systems:
• effective service delivery
• a well-trained, sufficiently-staffed workforce
• a robust health-information system
• access to essential medical products and technologies
• adequate health financing
• strong leadership and governance.
5.1.1. Recommended country action
75. The following elements are essential for ensuring synergies between national HIV programmes,
strengthening each of the above health-system building blocks (including community-based
components), and maximizing programme performance and related health outcomes.
76. Adapt service delivery models. Appropriate models of cost-effective service delivery that
produce good health outcomes need to be selected (or adjusted) to meet the needs of populations at
risk of HIV infection and people living with HIV (outlined in Section 3.1), with a strong focus on
expanding access and improving the quality of HIV services through integrated, decentralized
approaches. Community-based systems have a vital role to play in planning and implementing HIV
services, particularly those for key populations. As national HIV responses shift significant services
towards the community level, it is essential that community-based service-delivery providers be
involved in planning so as to ensure strong links and coordination between formal and informal
health-care settings. HIV services need to be quality assured through external and internal qualitymanagement systems, irrespective of the health-delivery setting.
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77. Mobilize financing for health and strengthen social protection systems. Mobilizing adequate
financing from domestic or foreign donors for health, social protection and community systems will be
the key to continuing the expansion of HIV services and keeping pace with increased demand.
Funding should be channelled in ways that strengthen domestic means of health financing, based on
national health priorities, and that ensure efficiency gains wherever possible. Health financing should
minimize out-of-pocket expenditures, cover health services at the point of care, and reduce other
financial barriers to accessing HIV services. Improving health equity in access to services can be
supported by focusing on access in rural areas, and poor, vulnerable and most-at-risk populations.
78. Strengthen human resources for health. Training, recruitment and task-shifting strategies
should be implemented to strengthen health workforce capacity. Countries should adhere to the WHO
Global Code of Practice on the International Recruitment of Health Personnel1 and ethical guidelines
that minimize the migration of health workers from low-income to high-income countries, and from
the public health sector to private and nongovernmental sectors.
79. In all settings, health workers must be competent to work with people living with HIV and
affected populations by integrating HIV content into pre- and in-service training. The risk of health
workers acquiring HIV in the workplace should be prevented with comprehensive occupational health
and safety procedures (see Strategic direction 1), and guaranteed compensation for occupationally
acquired illness. Policies and practices should be followed in order to ensure safe and supportive
workplace environments for health-care workers and the ethical treatment of health-care workers
living with HIV, including access to treatment and care. People living with HIV and community lay
workers play vital roles in delivering HIV services and training health workers; their knowledge and
skills can be supplemented through certification of skills in service delivery, and pay.
80. Improve strategic health information systems. Information systems in HIV programmes should
be strengthened through integration and harmonization with broader national health information
systems, including (to the extent possible) electronic information systems. Surveillance systems
should provide routine, standardized data with consistent methods, tools and populations surveyed and
move towards integration with the Country Health Systems Surveillance platform developed by WHO.
National HIV programmes should collaborate with other stakeholders to design, implement and
strengthen national monitoring and evaluation systems using WHO’s guidance and tools. The
monitoring and evaluation system should include:
• tools and processes for generating, analysing and reporting on interventions for HIV
prevention, diagnosis, treatment and care, including outcome and impact measures that will
enable progress made towards universal access goals and targets to be reported
• a national patient-monitoring system that supports the collection of core data such as patient
retention and disease progression
• a national strategy for prevention and assessment of HIV drug resistance
• a national pharmacovigilance programme that includes antiretroviral medicines.
81. Support should be provided for operational research and greater collaboration between
researchers and policy-makers to ensure that research findings are translated into practice. Research
capacity can be increased through collaboration among national partners, donors, and between
research organizations and networks.
1
Resolution WHA63.16.
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82. Ensure access to medicines, diagnostics and other commodities. Countries should secure
continued access to affordable medicines, diagnostics and other commodities needed for the HIV
response. National policies should be established to enable rapid regulatory approval of new and
generic medicines and diagnostics and expedite their marketing approval. In order to contain costs, an
open, competitive market should be fostered for these commodities, including (as needed) the use of
the flexibilities available under the World Trade Organization Agreement on Trade-Related Aspects of
Intellectual Property Rights, patent pooling and voluntary licence agreements between patent holders
and generic manufacturers. The Medicines Patent Pool is a means to enhance availability and facilitate
the development of new fixed-dose combinations and adapted formulations, such as paediatric
formulations, through voluntary licence agreements. Supply-management systems for health
commodities must be strengthened in order to improve the ability of those systems to distribute
commodities to all service-delivery points.
83. Planning and coordination of the procurement, deployment, maintenance and quality assurance
of point-of-care and laboratory-based technologies should be elements of national HIV responses.
Laboratory systems must ensure reliability and accuracy in the technologies and platforms used to
diagnose and monitor HIV infection and associated co-morbidities, monitor the immunological and
virological aspects of HIV infection, monitor treatment including HIV drug resistance, and perform
basic investigations for haematology and chemistry. Quality-management systems (including staff
training tailored for laboratory and health workers based in formal or informal health settings) should
be implemented.
84. Strengthen leadership, governance and strategic planning. Strategic partnerships should be
forged among health sector service providers (including the public sector, civil society and the private
sector) and with other sectors to develop and implement national HIV responses. Ensuring synergy
and coherence between the HIV response, other health programmes and the multisectoral plan for HIV
is crucial. Inclusive policy dialogue within and beyond the health sector should be fostered in order to
ensure universal coverage, social justice and equity in national responses to HIV.
5.1.2 WHO’s contribution
85. Promote efficiencies in service delivery. WHO will provide normative guidance on models of
integrated, decentralized HIV service delivery for different epidemic types, based on review and
evaluation of available evidence, including outlining the role of community-based health services.
WHO will further streamline the integrated management tools in order to provide a simplified,
efficient approach to service delivery.1 It will support strengthening community systems which hold
the key to improving the quality, efficiency and coverage of HIV services. It will strengthen civil
society involvement in its policy development and implementation, such as Treatment 2.0 and the
elimination of new HIV infections in children.
86. Support efforts to finance the HIV response fully. WHO will work with UNAIDS to estimate
the investments needed to achieve global HIV goals. It will advocate a fully-funded response through
domestic and foreign aid investments. WHO will develop and help to implement tools for costing
national health sector plans and services. Support will be provided to develop national healthfinancing plans that incorporate HIV programmes, and for operational research on innovative,
sustainable health-financing mechanisms. WHO will work with funding and development partners to
improve development assistance and technical support. WHO will provide technical support to help
1
These tools include the Integrated Management of Adolescent and Adult Illness, Integrated Management of
Childhood Illness, Integrated Management of Pregnancy and Childbirth and Integrated Management for Emergency and
Essential Surgical Care.
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145
countries to mobilize and implement external funding, including financing from the Global Fund to
Fight AIDS, Tuberculosis and Malaria.
87. Support efforts to strengthen health workforces. WHO will provide policy and technical
guidance aimed at building an expanded, well-trained health workforce that incorporates communitybased services to meet the health needs of communities. It will formulate, in partnership with countries
and civil society organizations, evidence-based recommendations on expanding medical and nursing
education and improving access to health workers (including community and lay workers) in
underserved areas. Countries will be supported to build capacity for collecting and analysing data on
the health workforce. Policy development will link to different sectors, including education, labour
and finance, in order to ensure a coordinated, sustainable approach to strengthening the health
workforce. WHO will draw on work to date with ILO, the United States’ President’s Emergency Plan
for AIDS Relief and other partners to refine strategies on strengthening health workforce training,
task-shifting, retention of health workers, and education.
88. Support improvements in strategic health information. WHO will provide guidance and
support for improved collection, analysis and use of data in the health sector. WHO will support
implementation of national longitudinal, interlinked patient-monitoring systems, including electronic
formats, for HIV, HIV/tuberculosis coinfection, and other priority health sector interventions.
Particular attention will be paid to supporting patient retention, data quality and quality of care. WHO
will monitor and report annually on health sector progress towards universal access and the impact of
HIV interventions on health-related Millennium Development Goals.
89. Shape the research agenda and stimulate the generation, translation and dissemination of
knowledge. WHO will advocate adequate investment in HIV research and development and, with
partners, set a global research agenda for the health sector response to HIV. It will promote the
generation and application of new knowledge, with particular emphases on national ownership,
improving the effectiveness of interventions and programmes, and promoting innovation. WHO will
drive the research agenda on HIV treatment and preventive interventions based on antiretroviral
medicines through the main work areas of the Treatment 2.0 platform (see Section 3.3.2).
90. Support increased access to affordable medicines, diagnostics and other commodities. WHO
will support strategies for lower pricing and improved procurement of HIV-related medicines and
commodities. Support will be provided to improve the procurement of HIV-related medicines,
diagnostics and other commodities by disseminating information on medicines and diagnostics
through the AIDS Medicines and Diagnostics Service, and promoting pooled procurement
mechanisms and other measures to improve supply-chain management and reduce the risk of stocks
running out of antiretroviral medicines and other health commodities. WHO will contribute to
improved market transparency and a sustainable supply of HIV-related commodities by monitoring
prices and forecasting demand. The selection for procurement of HIV-related commodities will be
improved through prequalification and timely inclusion in the WHO Model List of Essential
Medicines and the International Pharmacopoeia monographs. WHO will provide support to countries
in delivering an uninterrupted supply of HIV-related commodities through technical assistance,
capacity building and training in the effective use of tools for procurement and supply management.
91. WHO will also provide support and normative guidance on accessing simplified, qualityassured point-of-care and laboratory-based diagnostics and monitoring tools as part of the
Treatment 2.0 initiative. Guidance and technical support will be provided to facilitate procurement and
deployment of laboratory and point-of-care technologies and technical assistance to bolster national
laboratory strategic planning, capacity building and implementation of quality assurance mechanisms.
WHO will promote efforts for integrated and harmonized laboratory strengthening for HIV,
tuberculosis, malaria and other important health issues, through such mechanisms as the Global
Laboratory Initiative.
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92. Support national strategic planning and reviews. WHO will collaborate with UNAIDS and the
World Bank to ensure that the health sector is adequately resourced in multisectoral planning for the
HIV response and that HIV is adequately included in other health sector planning. WHO will support
reviews of national HIV plans, with particular attention to seeking synergy in the health system and to
the efficient use of resources. WHO will further develop tools to guide national strategic planning
processes and HIV programme reviews designed to improve health service management.
6. STRATEGIC DIRECTION 4: REDUCE VULNERABILITY AND REMOVE
STRUCTURAL BARRIERS TO ACCESSING SERVICES
93. The health sector plays an essential role in reducing HIV vulnerability, reducing HIV-related
stigmatization and discrimination, and removing structural barriers to accessing HIV services. The
HIV response has been a public health trailblazer in promoting human rights, mobilizing communities,
contributing to health equity and addressing social determinants of health. Removing gender-based
health inequities and protecting the rights of people living with HIV and key populations are crucial
steps to achieving universal access goals and health-related Millennium Development Goal targets.
Gender-based health inequities and human rights protections for women, girls and key populations
have not been adequately dealt with in national HIV responses to date. The most recent country
progress reports indicate the following:
• less than half the countries have a budget for HIV-related programmes that aim at women and
girls
• 67% of countries have laws, policies or regulations that posed obstacles to effective HIV
service provision for key populations
• The People Living with HIV Stigma Index (results from 10 countries) indicates high rates of
physical and verbal abuse experienced by people living with HIV, among which a significant
proportion (from 12% to 88%) were denied access to health services.
94. Not only must specific interventions be implemented in the health sector, but policies and
programmes in other sectors must be revised to reduce gender-based inequities and ensure human
rights protections for key populations. The health sector also has an important role to play in providing
evidence on the links between gender equity, human rights, the social determinants of health, and
HIV. These elements should be covered in the design, implementation and monitoring of health sector
interventions. Key elements are:
• promote gender equality and remove harmful gender norms
• advance human rights and promote health equity
• ensure health in all policies, laws and regulations.
6.1
Promote gender equality and remove harmful gender norms
95. National HIV responses can significantly reduce gender-based vulnerability to HIV infection in
their communities (such as intimate partner violence) and gender-based inequities in access to health
services. Health sector policies and programmes should empower women and girls to reduce their
vulnerability to HIV, challenge harmful gender norms, and contribute to gender equality. Genderbased differential access to health interventions, such as antiretroviral therapy, should be addressed in
HIV programming, and boys and men included in behavioural and structural interventions aimed at
reducing gender inequality.
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6.1.1 Recommended country action
96. Collect gender-based health information. Information systems for HIV and broader health
aspects should collect and analyse sex- and age-disaggregated data in order to identify HIV
transmission patterns, health-service inequities and programme impact among girls and boys, men and
women.
97. Include gender issues in the design, delivery and monitoring of health services. A focused,
integrated approach to removing gender-based health inequities will improve the quality, uptake and
impact of health services. HIV programmes should promote equity between the sexes in sexual
decision-making, including negotiation of safer sex and use of male and female condoms. Financial
and human resources should be allocated to programmes aimed at overcoming gender-related barriers
to accessing health services. Specific attention should be given to female carers so as to ensure that
they have good, equitable working conditions, and are empowered to participate in leadership roles in
health and community systems. Services relating to gender-based violence, including comprehensive
services for survivors of rape and other sexual violence, should be introduced.
6.1.2 WHO’s contribution
98. Support improved gender equity and the generation of evidence related to gender-based
health inequities. WHO will support countries to identify and overcome gender-based barriers to
access to services and related social inequalities. It will also provide support for advocacy and research
on the relationship between HIV risk, gender-based violence and other human rights violations, and
will provide guidance on the implementation of programmes addressing violence against women.
WHO will include women (including women living with HIV) and community carers in developing
policies and normative guidance aimed at ensuring that HIV services meet the needs of women.
6.2
Advance human rights and promote health equity
99. Legal and sociocultural barriers prevent people who use drugs, men who have sex with men,
transgender people, prisoners and sex workers from accessing effective interventions and using health
services. Laws and policies that criminalize possession of drug paraphernalia (such as clean needles to
support safe injecting practices) should be removed in order to expand access to health services and
improve their quality. Overcoming such structural barriers to access is crucial for improving uptake of
health services and ensuring a consistent, equitable approach in national HIV responses.
6.2.1 Recommended country action
100. Involve people living with HIV and key populations in the design, implementation and
evaluation of national HIV responses. National HIV responses should implement and monitor
policies and practices aimed at eliminating stigmatization, discrimination and other human rights
abuses in health service delivery. The impact of HIV-related stigmatization, discrimination and other
human rights abuses on access to health services and health outcomes should be documented. Links
should be established with broader accountability mechanisms (such as the high-level meetings of the
United Nations General Assembly special session) that assess progress in protecting human rights,
including the right to health.
6.2.2 WHO’s contribution
101. Promote the adoption of policies, practices and laws that protect human rights and
eliminate discrimination in the health sector. WHO will support evaluations of differential access to
health services and health outcomes. It will develop guidance and tools to change discriminatory
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attitudes among health-care workers towards people living with HIV and key populations. It will
promote non-discriminatory standards of care in health services. It will also develop country tools to
assess determinants of health risk and vulnerability, and to identify key populations and locations
where HIV risk and transmission are elevated. WHO will promote disaggregation of data by sex, age
and other stratifiers to support analyses of health equity, including differential access to health services
and variances in health outcomes.
6.3
Ensure health in all policies, laws and regulations
102. The health sector has a unique role to play in ensuring that policies, laws and regulations in
other sectors support national HIV responses, particularly in eliminating gender inequity and
protecting and promoting the human rights of key populations.
6.3.1 Recommended country action
103. Use public health evidence to introduce pro-health action in other sectors. Health-related
aspects of HIV should be considered in the development and review of policies, laws and regulations
in other sectors so as to ensure that they do not increase HIV vulnerability, discriminate or in other
ways impede access to services (e.g., in housing, social welfare, labour, immigration, defence, finance,
education, foreign affairs and development). Laws should be reviewed and, if necessary, reformed in
order to decrease HIV vulnerability, improve access to health services and protect human rights.
Legislation should be enacted to uphold non-discrimination in all areas. Specific attention should be
paid to: travel restrictions, employment, homophobia, sex work, drug control laws and criminalization
of HIV transmission. A public-health approach to managing behaviours that put people at risk of HIV
acquisition should be promoted as an alternate to criminalization. Sentencing alternatives to
incarceration should be promoted as good public health practice.
6.3.2 WHO’s contribution
104. Provide public health evidence to inform policies, laws and regulations in other sectors. WHO
will bring increased attention to the health needs of key populations and help to define the role of other
sectors in ensuring that these needs are met. WHO will support countries to draft or review healthrelated policies and legislation to ensure public health issues are adequately addressed. Public health
evidence will be provided in order to influence strategies and plans in other sectors. WHO will work
with partners at all levels to improve policy coherence, particularly with the main donor and
development agencies and initiatives, including the Global Fund to Fight AIDS, Tuberculosis and
Malaria, the United States’ President’s Plan for AIDS Relief and other bilateral programmes.
7.
STRATEGY IMPLEMENTATION
105. The effective implementation of the strategy depends on concerted action by all stakeholders in
the health sector response to HIV. Within the health sector, linkages across different disease-specific
and cross-cutting programmes need to be established and strengthened. This section describes how the
WHO Secretariat will organize itself to support implementation of the strategy. It also outlines how
the health sector response dovetails with other sectoral responses and partners, and how the
implementation of the strategy will be monitored and reported.
7.1
Optimizing WHO’s HIV Programme
106. The Secretariat will strengthening alignment and harmonization among the many country,
regional and global stakeholders. WHO’s HIV Programme embraces action taken at all three levels of
the Organization and across a wide range of departments and units. The Department of HIV in
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149
headquarters is responsible for coordinating the overall Programme. Each of the six regional offices
has a dedicated HIV unit. Many WHO country offices have staff working full-time or part-time on
HIV. WHO will optimize its HIV Programme structure and operations through the following
activities.
107. Implementing a clear division of labour across the three levels of the WHO Secretariat.
Headquarters will focus on global policy and normative work and be responsible for global monitoring
and reporting on the HIV pandemic and response. Global guidance will be streamlined so as to ensure
timely communication of new recommendations and greater coherence. Regional offices will focus
their efforts on coordination and facilitation of technical support to countries, including adaptation of
global guidance at country level. Country offices will focus their efforts on providing strategic policy
advice to health ministries and convening country partners around key issues.
108. Maximizing the synergies across other programme areas. The Secretariat’s work on HIV
links with a range of other high-priority areas within the Organization, including: health system
strengthening; health-information systems; maternal, newborn and child health; sexual and
reproductive health; tuberculosis and other infectious diseases; blood and injection safety; emergency
and surgical care; nutrition; noncommunicable diseases and mental health; gender and women’s
health; vaccine development; access to essential medicines; innovation and intellectual property; social
determinants of health; health law, human rights and ethics; and health in humanitarian crises. The
strategy promotes strong linkages across these health programmes. Priority will be given to
strengthening integration of HIV into the core work of these other programme areas. Mechanisms for
joint planning and coordination across programmes will be enhanced. For example, WHO’s support to
the Elimination of New HIV Infections in Children initiative will be coordinated across units
responsible for HIV, maternal and child health, sexual and reproductive health, and nutrition. WHO’s
contribution to Treatment 2.0 will be coordinated across units responsible for HIV, tuberculosis,
essential medicines and diagnostics, child and adolescent health, and nutrition.
109. Leveraging the capacity of technical networks and partners. WHO depends on partners to
implement its policies and guidance in countries. It will work with partners at all levels on improving
policy coherence, particularly with major donor and development agencies and initiatives, including
the Global Fund to Fight AIDS, Tuberculosis and Malaria, bilateral and multilateral programmes,
private foundations and implementing partners. WHO will aim to strengthen national institutions,
structures and systems for a sustainable response, working through knowledge hubs, WHO
collaborating centres and technical networks. WHO plays an important convening role in promoting
collaboration between civil society, the government and the private sector. Civil-society partners
provide technical and programming support for WHO’s work, including advocacy and development
and implementation of policies, tools and guidelines. WHO’s collaboration with civil society is
particularly important in ensuring that essential services are delivered to populations not reached by
state services and advocating for evidence-based policies, adequate resources, greater accountability
and human rights protections for key populations.
110. Building the capacity of WHO staff. WHO will invest in developing the core competencies of
its HIV Programme staff, focusing on the technical and policy areas required to deliver on the four
strategic directions of the strategy. Management skills will be strengthened to ensure efficiency,
effectiveness and the ability of the Organization to adapt to a changing environment.
111. Contributing to WHO and broader United Nations reform. Within the United Nations
system, the HIV response has acted as a pathfinder for reform in a range of areas, including improved
mechanisms for interagency collaboration, meaningful involvement of affected populations and
broader civil society, multisectoral engagement, promotion of country ownership, increased
accountability across all stakeholders and stimulation of innovative financing mechanisms. WHO will
continue to promote the pathfinding role of the HIV Programme. WHO will actively participate in
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country-level structures and processes that support national HIV and broader health plans and
priorities, in accordance with the principles set out in the Paris Declaration on Aid Effectiveness.
7.2
WHO as a cosponsor of UNAIDS
112. WHO’s collaboration within the United Nations system in the area of HIV is primarily managed
through the mechanisms and structures of UNAIDS, including the Committee of Cosponsoring
Organizations and the Programme Coordinating Board at the global level, meetings of the Regional
Directors Group of UNAIDS Cosponsors at the regional level and United Nations Theme Groups on
HIV/AIDS and Joint United Nations Teams on AIDS at country level.
113. The UNAIDS Division of Labour aims to coordinate roles, responsibilities and actions across its
cosponsors and its own secretariat. Among the UNAIDS cosponsors, WHO leads the health-sector
response to HIV, acts as the convening agency on the priority areas of HIV treatment and care and
HIV/tuberculosis, and jointly coordinates with UNICEF work on prevention of mother-to-child
transmission of HIV. Details on WHO’s collaboration with other UNAIDS cosponsors and other
partners are outlined in the Appendix.
7.3
Collaboration with other partners
114. WHO has an important convening role in bringing together different constituencies, sectors and
organizations in support of a coordinated and coherent health sector response to HIV. In addition to its
Member States and the other UNAIDS cosponsors and the UNAIDS secretariat, the WHO Secretariat
works closely with other key partners, including bilateral donor and development agencies and
initiatives, funds and foundations, civil society, technical institutions and networks, the commercial
private sector and partnership networks.
7.4
Monitoring, evaluating and reporting
115. Implementation of the strategy will be monitored at four levels, using existing mechanisms.
7.4.1 Monitoring and reporting of progress towards global goals and targets
116. At the global level, regular reviews are planned to assess progress on the commitments and
targets established in the United Nations Declaration of Commitment on HIV/AIDS, Political
Declaration on HIV/AIDS and Millennium Development Goals. These reviews will build on the data
received from countries through the reporting framework set by the United Nations General Assembly
Special Session on HIV/AIDS and other monitoring and evaluation mechanisms.
117. Progress at global and regional levels in moving towards the targets set out in this strategy will
be regularly assessed. Benchmarking – or comparisons between and within countries – will also be
used to assess performance in reaching targets. The strategy is designed to be sufficiently flexible to
incorporate additional priorities or fill gaps in the health sector response to HIV that may be identified
at the High Level Meeting scheduled to be held in June 2011 or other meetings to review progress on
global and national goals and targets.
118. To this end, WHO will continue to work with UNAIDS and other bodies to provide support to
countries for the harmonized and standardized collection of core indicators, and in the preparation of
global and regional reports. Annual reporting of the previous year’s data is proposed, and UNAIDS
will support a full review of universal access in June 2016.
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7.4.2 Monitoring and evaluating the response at country level
119. Progress in implementing the health-sector response to HIV should be assessed with indicators
on availability, coverage outcome and impact, taking into consideration recommendations by the
United Nations General Assembly for monitoring implementation in its Declaration of Commitment
on HIV/AIDS. Progress towards the HIV-related Millennium Development Goals will be tracked and
reported. Numerous indicators are available to support country-level monitoring and reporting in the
HIV Indicator Registry.
120. Indicators for monitoring the strengthening of health systems derive from a common platform
for monitoring and evaluating national health strategies, known as the Country Health Systems
Surveillance platform, coordinated by WHO. Instruments are also available for measuring progress in
implementing policy, legal and structural measures for enhancing the HIV response, as recommended
under strategic direction 4. These include the National Composite Policy Index, part of the reporting
system on implementing the United Nations General Assembly’s Declaration of Commitment on
HIV/AIDS,1 and The People Living with HIV Stigma Index, which involves a survey conducted by
and for people living with HIV in order to document the extent and forms of stigmatization and
discrimination in different countries, including those experienced in health services.
121. The table below lists core indicators for monitoring implementation of the Declaration of
Commitment on HIV/AIDS and for tracking progress towards Millennium Development Goals that
are proposed for consideration at country level. All indicators are to be sex- and age-disaggregated, as
appropriate, and analyses should be conducted to determine whether the response adequately addresses
key social determinants of HIV vulnerability and risk, including gender inequality, and takes the
necessary steps to achieve equitable access to services. Working towards equity involves analyses of
differences within and between groups, within and across countries, using a series of stratifiers and
summary measures.
1
United Nations General Assembly Special Session on HIV/AIDS. Monitoring the Declaration of Commitment on
HIV/AIDS: guidelines on construction of core indicators: 2010 reporting. Geneva, UNAIDS, 2009.
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SIXTY-FOURTH WORLD HEALTH ASSEMBLY
Table Selected core indicators proposed for country consideration
Core indicatorsa
Strategic direction
1. Optimize HIV
prevention, diagnosis,
treatment and care
outcomes
1.1
1.2
1.3
1.4
Percentage of young people aged 15–24 years who are HIV infected
Number of deaths associated with HIV
Number of new HIV infections among children 0–4 years of age
Percentage of men and women aged 15–49 years who received an
HIV test in the previous 12 months and know their results
1.5 Percentage of eligible adults and children with HIV infection who
receive antiretroviral therapy
1.6 Number of HIV-positive individuals who receive trimethoprimsulfamethoxazole prophylaxis according to national guidelines
1.7 Percentage of estimated number of HIV-positive patients with incident
tuberculosis who received treatment for HIV and tuberculosis
1.8 Percentage of HIV-infected pregnant women who received
antiretroviral medicines to reduce the risk of mother-to-child
transmission of HIV
2. Leverage broader
health outcomes
through HIV
responses
2.1
2.2
2.3
2.4
3. Build strong and
sustainable systems
3.1 Recommended core indicators from the Monitoring Health Systems
Strengthening Handbook of Indicators and Related Measurement
Strategiesb
4. Reduce
vulnerability and
remove structural
barriers to accessing
services
4.1 Completion of the National Composite Policy Index
4.2 Completion of The People Living with HIV Stigma Indexc
4.3 Availability of service-delivery points providing appropriate medical,
psychological and legal support for women and men who have been
raped or experienced incest
Unmet need for family planning
Maternal mortality ratio
All-cause mortality rate among children aged 0–4 years
Proportion of tuberculosis cases detected and cured under
directly-observed treatment, short course
a
Indicators for monitoring implementation of the Declaration of Commitment on HIV/AIDS are in italics; indicators
for tracking progress towards Millennium Development Goals are in bold.
b
For example, most countries will find it useful to track changes in availability of medicines at service delivery
level, using the following core indicator: percentage of facilities that have all tracer medicines and commodities in stock,
which is described in the WHO handbook (Monitoring health systems strengthening: a handbook of indicators and related
measurement strategies. Geneva, World Health Organization, 2010).
c
This includes consideration of stigmatization and discrimination in the health services, as measured by the
percentage of respondents who report that they were denied health services, including dental care, in the previous year
because of their HIV status.
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153
7.4.3 WHO’s framework for results-based management
122. WHO’s Medium-term strategic plan 2008–2013, which sets the Organization’s strategic
direction for that period, contains 13 strategic objectives. Much of WHO’s HIV-related work comes
under Strategic objective 2: To combat HIV/AIDS, tuberculosis and malaria, but there are significant
HIV-related activities under six other strategic objectives (1, 4, 6, 7, 10 and 11). Each strategic
objective has a set of organization-wide expected results with indicators, targets and resource
requirements. Workplan implementation is monitored through a mid-term review at the end of the first
year of each biennium and progress towards the achievement of the organization-wide expected results
is reported at the end of each biennium.
7.4.4 UNAIDS’ accountability framework
123. WHO’s HIV work is reflected in UNAIDS’ Unified Budget and Workplan, which sets a single
biennial framework that promotes joint planning and budgeting across the 10 cosponsors and the
UNAIDS secretariat, resulting in a combined two-year workplan. Each cosponsor is responsible for
implementation of a set of broad activities related to their organizational mandate and the UNAIDS
Technical Support Division of Labour. The Unified Budget and Workplan is accompanied by a
performance-monitoring framework, which defines indicators against which progress in
implementation of the budget and workplan is measured. Annual progress reports are submitted to the
UNAIDS Programme Coordinating Board. The Unified Budget and Workplan will be replaced by an
integrated unified budget and accountability framework for the period 2012–2015, the Unified Budget,
Results and Accountability Framework, that includes a business plan, a results and accountability
framework and a budget.
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Appendix
WHO’s collaboration with other UNAIDS cosponsors and the UNAIDS Secretariat
Cosponsor
Areas of collaboration
Office of the United Nations
High Commissioner for
Refugees
Implementing the Inter-Agency Standing Committee Guidelines for
Addressing HIV in Humanitarian Settings; undertaking joint
assessments and planning for HIV responses in countries affected by
humanitarian crises; and adapting HIV guidelines and tools for
settings of humanitarian crises, including for most-at-risk
populations
United Nations Children’s
Fund
Prevention of mother-to-child transmission of HIV; treatment and
care of infants and children; HIV prevention, treatment and care of
young people; and strengthening of systems for procurement and
supply-chain management
World Food Programme
Implementation of nutritional guidelines for HIV care and treatment
in association with antiretroviral therapy and management of HIV
and tuberculosis coinfection; and supporting operational research
related to HIV treatment and care
United Nations
Development Programme
Integrating HIV issues into national planning and legislative
processes; countering stigmatization and discrimination in the health
sector; formulating strategies for enabling trade, health and
intellectual property legislation to increase affordability and access
to HIV-related medicines; HIV prevention, treatment and care for
men who have sex with men and transgendered people; training of
community-based treatment supporters; and reducing gender
inequity and dealing with gender-based violence
United Nations Population
Fund
Condom programming, standards and quality assurance; linking
sexual and reproductive health and HIV at the policy, systems and
service delivery levels; preventing HIV infections in pregnant
women, mothers and their children; sexual and reproductive health
for people living with HIV including prevention of mother-to-child
transmission of HIV; improving access of young people, women and
sex workers to prevention, treatment and care services for HIV and
sexually transmitted infections; eliminating gender-based violence;
and promoting gender equality, empowerment of women and girls,
and reproductive rights
United Nations Office on
Drugs and Crime
HIV prevention and care for injecting and non-injecting drug users
and in prison settings; advocacy of harm reduction and drugdependence treatment and rehabilitation policies and programmes;
and improving access to internationally controlled substances for the
management of opioid dependence, pain control and palliative care
International Labour
Organization
Integrating HIV issues into occupational safety and vocational
training programmes; human resources for dealing with HIV; and
providing policy guidance and practical measures to extend social
protection
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155
United Nations Educational,
Scientific and Cultural
Organization
HIV prevention and treatment and sexuality education in community
and school settings
The World Bank
National HIV strategic planning; health system financing for HIV;
and assessment of costs, cost-benefit and cost–effectiveness of HIV
interventions
UNAIDS secretariat
Global advocacy and resource mobilization for major health sector
initiatives; monitoring, evaluating and reporting on the HIV situation
and response; supporting the assessment and development of new
HIV prevention technologies, including HIV vaccines, microbicides
and pre-exposure prophylaxis, and the introduction of proven new
interventions, including male circumcision; facilitating discussions
with industry to achieve price reductions of HIV-related medicines
and commodities; coordinating and brokering technical assistance to
countries, including for accessing and implementing grants from the
Global Fund to Fight AIDS, Tuberculosis and Malaria; and
strengthening country coordinating mechanisms, including the
United Nations Theme Group on HIV/AIDS
_______________
ANNEX 5
Text of the amended Financial Regulations of the World Health Organization1
[A64/34 – 17 March 2011]
Regulation XIV – External audit
14.1 External Auditor(s), each of whom shall be the Auditor-General (or officer holding equivalent
title or status) of a Member government, shall be appointed by the Health Assembly. The term of
office shall be four years, covering two budgetary periods, and can be renewed once for an additional
term of four years. External Auditor(s) appointed may be removed only by the Assembly.
…
14.8 The External Auditor(s) shall issue a report on the audit of the annual financial statements
prepared by the Director-General pursuant to Regulation XIII. The report shall include such
information as he/she/they deem(s) necessary in regard to Regulation 14.3 and the Additional Terms
of Reference.
14.9 The report(s) of the External Auditor(s) shall be transmitted through the Executive Board,
together with the audited financial statements, to the Health Assembly not later than 1 May following
the end of the financial year to which the final accounts relate. The Executive Board shall examine the
annual financial statements and the audit report(s) and shall forward them to the Health Assembly with
such comments as it deems necessary.
_______________
1
Text amended in accordance with resolution WHA64.22.
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ANNEX 6
Financial and administrative implications for the Secretariat
of resolutions adopted by the Health Assembly
1. Resolution WHA64.1 Implementation of the International Health Regulations (2005)
2. Linkage to programme budget
Strategic objective:
1. To reduce the health, social and
economic burden of communicable
diseases.
Organization-wide expected result:
Expected results 1.1, 1.5, 1.6, 1.7, 1.8 and 1.9.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The recommendations of the Review Committee link directly to indicators 1.6.1 (Number of Member
States that have completed the assessment and developed a national action plan to achieve core
capacities for surveillance and response in line with their obligations under the International Health
Regulations (2005)) and 1.6.2 (Number of Member States whose national laboratory system is engaged
in at least one external quality-control programme for epidemic-prone communicable diseases).
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat's activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities)
The Secretariat’s work in support of implementation of recommendations 1–3, 5–13 and 15
entails an estimated additional cost of US$ 75.51 million. Recommendations 4 and 14, directed to
States Parties, are not included in this cost estimation.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
The estimated cost for implementing the recommendations is US$ 6.31 million.
Of this, US$ 1.40 million will be incurred at regional office level (all six WHO regions) and
US$ 4.91 million at the headquarters level.
(c) Is the estimated cost noted in (b) included within the existing approved Programme budget
for the biennium 2010-2011?
At the regional office level (all six regional offices) it is estimated that US$ 600 000 is already
included. At headquarters level it is estimated that US$ 3.75 million is already included.
4. Financial implications
How will the estimated cost noted in 3 (b) be financed (indicate potential sources of funds)?
Requests will be made for additional voluntary contributions.
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5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Most of the recommendations contained in the report will require additional activities at both the
headquarters and regional office levels. By far the largest activity, and cost component, of the
recommendations is the support required to accelerate the achievement of the national core
capacities referred to in recommendation 1. There will be a particular need for actions at regional
office level in order to implement this resolution.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
It is estimated that an additional 32 staff in the professional and higher categories will be needed;
the staff in question will be deployed in roughly equal numbers between headquarters and the
regional offices.
(d) Time frames (indicate broad time frames for implementation of activities).
The time frame for implementation is until end of 2015.
1. Resolution WHA64.2 WHO reform
2. Linkage to programme budget
Strategic objective:
All strategic objectives.
Organization-wide expected result:
All Organization-wide expected results.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution relates to the agenda for reform of the whole Organization; as such, it is linked directly to
all expected results, indicators, targets and baselines. The resolution only concerns the overall design of
the programme of reform (and specific elements thereunder) and not its implementation; as such only the
design activities are costed.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
Activity 1
The Secretariat’s work to prepare a detailed concept paper on the World Health Forum, to be held
in 2012, is costed as follows:
100% of one full-time equivalent staff member at grade D.2 over 20 days (US$ 20 000); 100% of
one full-time equivalent staff member at grade P.2 over 20 days (US$ 10 000).
Total cost: US$ 30 000.
Activity 2
The cost of the Secretariat’s work to develop an approach to independent evaluation (A.) and the
cost of the independent evaluation (B.):
A. 100% of one full-time equivalent staff member at grade P.3 over 180 days (US$ 90 000);
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159
100% of one full-time equivalent staff member at grade G.4 over 180 days (US$ 50 000).
Subtotal: US$ 140 000
B. US$ 500 000 for the independent evaluation group (consultant team).
Total cost: US$ 640 000.
Activity 3
The development of the programme of reform by a competitively selected and contracted
consulting firm (B.) in conjunction with the Secretariat (Project Team) (A.) is costed as follows:
A. 100% of one full-time equivalent staff member at grade P.2 over 180 days (US$ 80 500);
100% of one full-time equivalent staff member at grade P.5 over 180 days (US$ 131 100); 20%
of one full-time equivalent staff member at grade D.2 over 180 days (US$ 32 028); 40% of one
full-time equivalent staff member at grade D.2 over 180 days (US$ 64 055).
Subtotal: US$ 310 000
B. US$ 490 000 for the work of a competitively selected consulting firm.
Total cost: US$ 800 000.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
Total of activities 1–3 outlined in (a) above: US$ 1.47 million incurred at headquarters level.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Yes.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Some financing has been secured from the Bill & Melinda Gates Foundation; some additional
financing will also be requested from other sources.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Headquarters.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
Yes.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Not applicable.
(d) Time frames (indicate broad time frames for implementation of activities).
Activity 1: June – September 2011
Activity 2: June 2011 – February 2012
Activity 3: June – October 2011.
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1. Resolution WHA64.4 Health conditions in the occupied Palestinian territory, including east
Jerusalem, and in the occupied Syrian Golan
2. Linkage to programme budget
Strategic objective:
5. To reduce the health consequences of
emergencies, disasters, crises and conflicts,
and minimize their social and economic
impact.
Organization-wide expected result:
5.3 Norms and standards developed, capacity built and
technical support provided to Member States for
assessing needs and for planning and implementing
interventions during the transition and recovery phases
of conflicts and disasters.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
If fully funded and implemented, the resolution is expected to have an impact on the targets for the
second and third indicators for the expected result.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities)
US$ 3.92 million over the one-year period of the resolution, including staff, travel, training
activities, technical assistance, health supplies, security and operational equipment.
The breakdown of the estimated cost of operative paragraph 5 is as follows:
Subparagraph (1)
US$ 100 000
Subparagraph (2)
US$
70 000
Subparagraph (3)
US$
50 000
Subparagraph (4)
US$
200 000
Subparagraph (5)
US$
500 000
Subparagraph (6)
US$ 3 000 000
Total
US$ 3 920 000
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 2.25 million.
(c) Is the estimated cost noted in (b) included within the existing approved Programme budget
for the biennium 2010–2011?
Seventy-five per cent of US$ 2.26 million at headquarters, Regional Office and Jerusalem Office
levels.
4. Financial implications
How will the estimated cost noted in 3 (b) be financed (indicate potential sources of funds)?
A substantial proportion of these resources has been raised as humanitarian voluntary contributions
through the Consolidated Appeal Process for addressing humanitarian health needs, implementing
life-saving interventions, re-establishing the functionality of disrupted health services and rolling out
the Interagency Standing Committee health cluster.
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161
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
The activities will be primarily implemented through the WHO Office in Jerusalem responsible
for WHO’s cooperation programme with the Palestinian Authority. WHO’s country-level efforts
will be supplemented by support from the Regional Office for the Eastern Mediterranean, and by
the headquarters clusters working in the areas of poliomyelitis eradication, emergency
preparedness and response, and country focus, health security and environment.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
It will be necessary to sustain beyond May 2011 the actual presence at country level of the
national and international staff recruited to implement humanitarian health activities and
interventions in the occupied Palestinian territory.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Not applicable.
(d) Time frames (indicate broad time frames for implementation of activities).
One year.
1. Resolution WHA64.5 Pandemic influenza preparedness: sharing of influenza viruses and access to
vaccines and other benefits
2. Linkage to programme budget
Strategic objective:
1. To reduce the health, social and
economic burden of communicable
diseases.
Organization-wide expected result:
1.4 Policy and technical support provided to Member
States in order to enhance their capacity to carry out
surveillance and monitoring of all communicable
diseases of public health importance.
1.7 Member States and the international community
equipped to detect, assess, respond to and cope with
major epidemic and pandemic-prone diseases (e.g.
influenza, meningitis, yellow fever, haemorrhagic
fevers, plague and smallpox) through the development
and implementation of tools, methodologies, practices,
networks and partnerships for prevention, detection,
preparedness and intervention.
1.9 Effective operations and response by Member
States and the international community to declared
emergency situations due to epidemic and pandemic
prone diseases.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
Achievement of the Organization-wide expected results mentioned above, together with the targets of
their indicators, will be given a major impetus through the following activities: conducting disease burden
studies; expanding and building influenza vaccine production capacity; expanding the use of potent
adjuvant technology; establishing stockpiles; building and strengthening laboratory and surveillance
capacity; and creating National Influenza Centres and WHO Collaborating Centres for Influenza.
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3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
The total cost over the five-year plan of the resolution amounts to US$ 287.0 million. The
breakdown is as follows:
• activities for laboratory and disease surveillance capacity in countries (US$ 105.8 million)
• activities for expanding global influenza vaccine production capacity in countries through
disease burden studies, building and expanding country capacity, and expanding use of
technology (US$ 97.0 million)
• activities for establishing a stockpile of antiviral medicines (US$ 67.0 million)
• activities and staffing of a Pandemic Influenza Preparedness Framework secretariat, including
an Advisory Group, to manage the progress of the Framework (US$ 17.2 million).
These budget estimates do not take into account costs associated with financial requirements
stemming from the next pandemic.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 2 million at headquarters for the period June to December 2011 (staff US$ 1.49 million;
activities US$ 510 000).
This amount covers activities and staffing in order to: draft notifications on the Framework;
establish membership of the Advisory Group; commence work on genetic sequences; establish a
industry partnership contribution fund, and prepare a proposal on the fund’s uses and management
for consideration by the Executive Board at its session in May 2012; commence negotiations with
companies and associations and other entities, and develop template legal agreements; and begin
development of a communications strategy and plan.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
No.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Financing models for implementation of the resolution are being considered. An account expected to
be funded by Member States, donors and industry is being proposed. Financing of the account will
depend on new voluntary funding being identified.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
In 2011 the Framework secretariat at headquarters will commence work, coordinating with
regional and country offices to set up the five-year plan of work for the resolution. As from 2012,
much of the implementation will take place at country level with technical support from
headquarters. Implementation will be coordinated by the Framework secretariat from
headquarters.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
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163
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents – by
levels of the Organization, identifying specific regions where relevant and noting necessary
skills profile).
The following additional staff will be needed:
• three full-time equivalent staff in the professional and higher categories to design and develop
training on the Influenza Virus Tracking Mechanism and to implement training courses across
countries in support of the Global Influenza Surveillance and Response System;
• one 50% full-time equivalent staff member to lead genetic sequencing consultations;
• one full-time equivalent fund manager and one full-time equivalent finance assistant to manage
the fund; and
• four full-time equivalent legal officers to negotiate with industry and to develop, among other
things, contribution agreements, pre-purchase agreements and intellectual property licensing.
Additional contractual resources will be needed for the translation of documents and agreements
(depending on the length of documents and language agreements). Additional support will also be
needed for review of the Framework and annexes by 2016.
(d) Time frames (indicate broad time frames for implementation of activities).
Activities will commence immediately and will continue until the Framework and annexes are
reviewed in 2016.
1. Resolution WHA64.6 Health workforce strengthening
2. Linkage to programme budget
Strategic objective:
10. To improve health services through
better governance, financing, staffing and
management, informed by reliable and
accessible evidence and research.
Organization-wide expected result:
10.8 Health-workforce information and knowledge
base strengthened, and country capacities for policy
analysis, planning, implementation, informationsharing and research built up.
10.9 Technical support provided to Member States,
with a focus on those facing severe health-workforce
difficulties in order to improve the production,
distribution, skill mix and retention of the health
workforce.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
WHO’s activities in support of health workforce strengthening have links with strategic objective 10,
specifically the two Organization-wide expected results mentioned above. The present resolution is also
linked to the implementation of resolution WHA63.16, in which (inter alia) the WHO Global Code of
Practice on the International Recruitment of Health Personnel was adopted.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
US$ 39.0 million over a period of six years, beginning 2011. This includes activities at
headquarters and in the regions.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 1.5 million at headquarters level and US$ 4.5 million at regional level.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
A total of US$ 1.0 million is included for headquarters and the regions.
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4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Costs will be met through income from core voluntary contributions from Member States and
international partners. In line with the implementation strategy for the Code developed by the
Secretariat, resource mobilization activities will be undertaken for this area with a particular
focus on certain Member States and international partners, since this is a mission-critical activity.
Indications of support have already been received from Japan, Norway, the United States of
America and the European Union.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
All levels of the Organization will be involved; however, implementation will particularly
concern countries facing major challenges as a result of critical health workforce shortages.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No. Additional staff will be required at headquarters and in the regions.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Exact requirements will depend on the intensity of activities. Every effort will be made to make
full use of secondments and the deployment of interns, in addition to employing short-term staff.
(d) Time frames (indicate broad time frames for implementation of activities).
An implementation strategy has already been developed by the Secretariat. Activities will be
implemented according to this strategy, which covers the period 2011–2015.
1. Resolution WHA64.7 Strengthening nursing and midwifery
2. Linkage to programme budget
Strategic objective:
10. To improve health services through
better governance, financing, staffing and
management, informed by reliable and
accessible evidence and research.
Organization-wide expected result:
10.8 Health-workforce information and knowledge
base strengthened, and country capacities for policy
analysis, planning, implementation, informationsharing and research built up.
10.9 Technical support provided to Member States,
with a focus on those facing severe health-workforce
difficulties in order to improve the production,
distribution, skill mix and retention of the health
workforce.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
WHO’s activities in support of health workforce strengthening have links with strategic objective 10,
specifically the two Organization-wide expected results mentioned above. Countries facing severe
nursing and midwifery difficulties will be supported through WHO’s activities to adopt relevant technical
frameworks, tools and guidelines for strengthening nursing and midwifery practice.
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165
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
A total of US$ 4.0 million, covering the four-year period 2011–2014, will be required for the
implementation of activities at all levels of WHO and the provision of support to Member States.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000, including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
For the biennium, a total of US$ 2.0 million will be incurred (US$ 500 000 at headquarters level
and US$ 1.5 million at regional level).
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
A total of US$ 400 000 is included for headquarters and the regions.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
The cost will be met through a combination of voluntary and assessed contributions from
Member States, together with contributions from international partners.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
All levels of the Organization will be involved; however, implementation will particularly
concern countries facing major challenges as a result of critical health workforce shortages.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No. Additional staff will be required at headquarters and in the regions.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Exact requirements will depend on the intensity of activities. Every effort will be made to make
full use of secondments and the deployment of interns in addition to employing short-term staff.
(d) Time frames (indicate broad time frames for implementation of activities).
The resolution requests the Director-General to report on progress to the Health Assembly in
2012 and 2014. Implementation of activities will be built into biennial workplans for 2010–2011,
2012–2013 and 2014–2015, as appropriate.
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1. Resolution WHA64.8 Strengthening national policy dialogue to build more robust health policies,
strategies and plans
2. Linkage to programme budget
Strategic objective:
10. To improve health services through
better governance, financing, staffing and
management, informed by reliable and
accessible evidence and research.
Organization-wide expected result:
10.1 Management and organization of integrated,
population-based health-service delivery through
public and nonpublic providers and networks
improved, reflecting the primary health care strategy,
scaling up coverage, equity, quality and safety of
personal and population-based health services, and
enhancing health outcomes.
10.2 National capacities for governance and leadership
improved through evidence-based policy dialogue,
institutional capacity-building for policy analysis and
development, strategy-based health-system
performance assessment, greater transparency and
accountability for performance, and more effective
intersectoral collaboration.
10.3 Coordination of the various mechanisms
(including donor assistance) that provide support to
Member States in their efforts to achieve national
targets for health-system development and global
health goals improved.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
This resolution is linked to resolution WHA62.12 on primary health care, including health system
strengthening.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat's activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
US$ 50 million over a period of six years.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 8 million at all levels of the Organization.
(c) Is the estimated cost noted in (b) included within the existing approved Programme budget
for the biennium 2010-2011?
Yes.
4.
Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Costs will be met through income from voluntary contributions from Member States and
contributions from international partners.
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167
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
All levels of the Organization will be involved.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Exact requirements will depend on the intensity of activities. Every effort will be made to make
full use of secondments in addition to employing short-term staff.
(d) Time frames (indicate broad time frames for implementation of activities).
The Secretariat is drawing up implementation plans.
1. Resolution WHA64.9 Sustainable health financing structures and universal coverage
2. Linkage to programme budget
Strategic objective:
10. To improve health services through
better governance, financing, staffing and
management, informed by reliable and
accessible evidence and research.
Organization-wide expected result:
All the Organization-wide expected results under
strategic objective 10, particularly:
10.10 Evidence-based policy and technical support
provided to Member States in order to improve healthsystem financing in terms of the availability of funds,
social and financial-risk protection, equity, access to
services and efficiency of resource use.
10.11 Norms, standards and measurement tools
developed for tracking resources, estimating the
economic consequences of illness, and the costs and
effects of interventions, financial catastrophe,
impoverishment, and social exclusion, and their use
supported and monitored.
10.12 Steps taken to advocate additional funds for
health where necessary; to build capacity in framing of
health-financing policy and interpretation and use of
financial information; and to stimulate the generation
and translation of knowledge to support policy
development.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution provides a framework that will contribute to the achievement of the expected results
mentioned above and links to the relevant indicators, targets and baselines.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
Implementation of the resolution will entail costs of US$ 9.0 million over the next six years, in
addition to the cost of US$ 4.8 million estimated for implementation of resolution WHA62.12.
This figure represents the cost of: scaling up technical and policy support to Member States in the
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area of health financing for universal coverage; linking this effort with national health plans and
strategies; and increasing capacity to share experiences across countries.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
All levels of the Organization are currently engaged in the provision of technical support to
countries in relation to financing for universal coverage; they all facilitate the sharing of
experiences across countries. The cost of scaling up these activities in order to meet the current
demand from countries, as well as the need to share across countries information on what has
worked and what has not worked, is estimated at US$ 1.50 million during 2011
(US$ 1.05 million for the regions and US$ 450 000 for headquarters).
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Some costs for technical support to countries and information sharing were included in the
Programme budget 2010–2011. The costs outlined here are additional costs required to meet the
growing demand for countries for this type of support partly in response to The world health
report 2010.1
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
A strategy for mobilizing the additional resources required in a resource-constrained environment
is being developed.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
All regions will engage in providing technical support to Member States. Headquarters will
support this effort, helping to coordinate increased exchange of information as requested by the
resolution – particularly since there is increasing demand for cross-regional exchanges. However,
regional and country offices will also be heavily involved in information-exchange activities.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
In order to meet the expected increase in demand from Member States for this type of support,
new staff will be required or existing staff will need to be redeployed. Many regional and country
offices do not have sufficient skills in health financing.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
The costs mentioned above include additional staff in the professional category in the area of
health financing policy (1.5 at headquarters and 3 in the regions).
(d) Time frames (indicate broad time frames for implementation of activities).
Health financing systems are always developing so requests for technical support will continue.
The time frame for this costing is set at three bienniums (six years).
1
The world health report 2010. Health systems financing: the path to universal coverage. Geneva, World Health
Organization, 2010.
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1. Resolution WHA64.10 Strengthening national health emergency and disaster management capacities
and the resilience of health systems
2. Linkage to programme budget
Strategic objective:
5. To reduce the health consequences of
emergencies, disasters, crises and conflicts,
and minimize their social and economic
impact.
Organization-wide expected result:
5.1 Norms and standards developed, capacity built and
technical support provided to Member States for the
development and strengthening of national emergency
preparedness plans and programmes.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The establishment and operation of a disaster risk-management and emergency-preparedness platform,
together with a functional safe hospitals programme at national level will help significant progress to be
made in the area of disaster risk-reduction, and emergency preparedness, response and recovery in
countries at risk. The resolution will further strengthen the all-hazards health emergency and disaster riskmanagement programmes as part of national health systems in order to improve health outcomes, reduce
mortality and morbidity, protect investment in health infrastructure and strengthen the resilience of the
health system and society at large.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
The figures provided concern the period until the end of 2013.
At headquarters level
The total estimated cost is US$ 7.44 million.
For the provision of technical assistance (consultancies, including short-term contracts,
Agreements for Performance of Work, scientific and technical advisory groups; travel; and
training): US$ 750 000.
Staff costs (P.5 staff for two years, P.4 staff for two years and G.4 staff for two years):
US$ 1.65 million. This figure is based on the estimated cumulative time to be spent by a number
of staff at different levels for this particular activity.
The estimated total cost of strengthening the evidence base for health emergency and disaster
risk-management, including operational research and economic assessments: US$ 2.79 million.
The estimated total cost of supporting national assessments of risks and capacities for health
emergency and disaster risk-management, as a basis for catalysing action and strengthening
national health emergency and disaster risk-management capacities: US$ 2.25 million.
At regional level
The total estimated cost: US$ 4.50 million (US$ 750 000 per regional office).
At country level
The estimated minimum cost of provision of technical support by the Secretariat through the
country offices to Member States implementing the resolution: US$ 250 000 per country.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
At headquarters level
For the provision of technical assistance (including consultancies involving short-term contracts
and Agreements for Performance of Work, travel, training, scientific and technical advisory
groups): US$ 250 000.
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For the strengthening of collaboration with relevant entities (including public, private and nongovernmental bodies and academia) to support country and community health emergency and
disaster risk-management, the estimated staff cost is: US$ 550 000 (P.5 staff, US$ 250 000;
P.4 staff, US$ 200 000; and G.4 staff, US$ 100 000). This figure is based on the estimated
cumulative time to be spent by a number of staff at different levels for this particular activity for
a period of one year.
The estimated total cost of strengthening the evidence base for health emergency and disaster
risk-management, including operational research and economic assessments: US$ 930 000.
The estimated total cost of supporting national assessments of risks and capacities for health
emergency and disaster risk-management, as a basis for catalysing action and strengthening
national health emergency and disaster risk-management capacities: US$ 750 000.
At regional level
The estimated total cost: US$ 1.50 million (US$ 250 000 per regional office).
At country level
The estimated minimum cost of provision by the Secretariat of technical support for
implementation through country offices: US$ 50 000 per country.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Yes, except at country level.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Through fund-raising and voluntary contributions.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Implementation will take place mainly in the country offices. Regional offices will provide
support for training and capacity building and headquarters will be responsible for interagency
coordination, overall planning and development of the evidence-based norms and guidelines
necessary to develop and strengthen this area of work. The WHO Mediterranean Centre for
Vulnerability Reduction in Tunis will provide technical assistance to all levels in areas of its
expertise.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
At the headquarters level, staffing is sufficient for the development component of this area and
the staff cost is budgeted. At the regional and national levels, there is a need for additional
expertise that could be recruited on a temporary basis (short-term contracts and Agreements for
Performance of Work).
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Not applicable.
(d) Time frames (indicate broad time frames for implementation of activities).
These activities are planned for the bienniums 2010–2011 and 2012–2013.
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1. Resolution WHA64.11 Preparations for the high-level meeting of the United Nations General
Assembly on the prevention and control of non-communicable diseases,
following the Moscow Conference1
2. Linkage to programme budget
Strategic objective:
3. To prevent and reduce disease, disability
and premature death from chronic
noncommunicable diseases, mental
disorders, violence and injuries and visual
impairment.
Organization-wide expected result:
3.1 Advocacy and support provided to increase
political, financial and technical commitment in
Member States in order to tackle chronic
noncommunicable diseases, mental and behavioural
disorders, violence, injuries and disabilities together
with visual impairment, including blindness.
3.2 Guidance and support provided to Member States
for the development and implementation of policies,
strategies and regulations in respect of chronic
noncommunicable diseases, mental and neurological
disorders, violence, injuries and disabilities together
with visual impairment, including blindness.
3.3 Improvements made in Member States’ capacity to
collect, analyse, disseminate and use data on the
magnitude, causes and consequences of
noncommunicable diseases, mental and neurological
disorders, violence, injuries and disabilities together
with visual impairment, including blindness.
6. To promote health and development,
and prevent or reduce risk factors for health
conditions associated with use of tobacco,
alcohol, drugs and other psychoactive
substances, unhealthy diets, physical
inactivity and unsafe sex.
6.2 Guidance and support provided in order to
strengthen national systems for surveillance of major
risk factors through development and validation of
frameworks, tools and operating procedures and their
dissemination to Member States where a high or
increasing burden of death and disability is attributable
to these risk factors.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
It is envisaged that there will be an increase in the number of Member States: (i) with a unit in the
ministry of health or equivalent national health authority, with dedicated staff and budget, for the
prevention and control of noncommunicable diseases (indicator 3.1.4); (ii) that have adopted a
multisectoral national policy on chronic noncommunicable diseases (indicator 3.2.3); (iii) with a national
health reporting system and annual reports that include indicators on the four major noncommunicable
diseases (indicator 3.3.4); (iv) with a functioning national surveillance system for monitoring major risk
factors to health among adults based on the WHO STEPwise approach to surveillance (indicator 6.2.1).
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
US$ 4.5 million over a period of three years.
1
First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control (Moscow,
Russian Federation, 28–29 April 2011).
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(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 1.0 million at all levels of the Organization.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Yes.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Costs will be met through income from voluntary contributions from Member States and contributions
from international partners.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
All levels of the Organization.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents – by
levels of the Organization, identifying specific regions where relevant and noting necessary
skills profile).
Every effort will be made to make full use of secondments from Member States, as well as
employing short-term staff.
(d) Time frames (indicate broad time frames for implementation of activities).
Three years for all activities (the Secretariat is drawing up an implementation plan accordingly).
1. Resolution WHA64.12 WHO’s role in the follow-up to the United Nations High-level Plenary
Meeting of the General Assembly on the Millennium Development Goals
(New York, September 2010)
2. Linkage to programme budget
Strategic objective:
10. To improve health services through
better governance, financing, staffing and
management, informed by reliable and
accessible evidence and research.
Organization-wide expected result:
10.4 Country health-information systems that provide
and use high-quality and timely information for health
planning and for monitoring progress towards national
and major international goals strengthened.
10.5 Better knowledge and evidence for health
decision-making assured through consolidation and
publication of existing evidence, facilitation of
knowledge generation in priority areas, and global
leadership in health research policy and coordination,
including with regard to ethical conduct.
10.11 Norms, standards and measurement tools
developed for tracking resources, estimating the
economic consequences of illness, and the costs and
effects of interventions, financial catastrophe,
impoverishment, and social exclusion, and their use
supported and monitored.
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(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The support to the work of the Commission on Information and Accountability for Women’s and
Children’s Health is expected to:
• lead to better knowledge and evidence for health decision-making at country and global levels
(expected result 10.5)
• contribute to strengthening of country health information systems (expected result 10.4)
• improved tracking of resources at country and global levels (expected result 10.11).
Using the current indicators, results of implementation can best be measured through the proportion of
low- and middle-income countries with adequate monitoring of the health-related Millennium
Development Goals that meet agreed standards (indicator 10.4.1). Currently, 40% of countries meet
standards; the target is 60% by 2013.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
US$ 2.5 million for provision of technical and administrative support to the Commission.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 2.5 million at headquarters.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
No.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Specified voluntary contributions provided by Member States for the work of the Commission.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Headquarters level.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
The resolution can be implemented by existing staff.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Not applicable.
(d) Time frames (indicate broad time frames for implementation of activities).
From January 2011 to September 2011.
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1. Resolution WHA64.13 Working towards the reduction of perinatal and neonatal mortality
2. Linkage to programme budget
Strategic objective:
4. To reduce morbidity and mortality and
improve health during key stages of life,
including pregnancy, childbirth, the
neonatal period, childhood and adolescence,
and improve sexual and reproductive health
and promote active and healthy ageing for
all individuals.
Organization-wide expected result:
4.1 Support provided to Member States to formulate a
comprehensive policy, plan and strategy for scaling up
towards universal access to effective interventions in
collaboration with other programmes, paying attention
to reducing gender inequality and health inequities,
providing a continuum of care throughout the life
course, integrating service delivery across different
levels of the health system and strengthening
coordination with civil society and the private sector.
4.3 Guidelines, approaches and tools for improving
maternal care applied at the country level, including
technical support provided to Member States for
intensified action to ensure skilled care for every
pregnant woman and every newborn, through childbirth
and the postpartum and postnatal periods, particularly
for poor and disadvantaged populations, with progress
monitored.
4.4 Guidelines, approaches and tools for improving
neonatal survival and health applied at country level,
with technical support provided to Member States for
intensified action towards universal coverage, effective
interventions and monitoring of progress.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution links with indicators 4.1.1, 4.3.1 and 4.4.1; the targets for those indicators will measure
progress in the implementation of the resolution.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
It is estimated that implementation of the resolution will cover the five-year period 2011–2015.
The estimated cost of implementation over this period at headquarters and in regional and country
offices is US$ 95.1 million.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
The estimated cost for the Secretariat at all levels during the remainder of the biennium would be
US$ 9.51 million.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Yes.
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4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Existing extrabudgetary sources are not sufficient to support all these costs. It is estimated that
US$ 500 000 of additional funds will be needed. The Secretariat will seek to identify sufficient
additional sources of funding to ensure that the resolution can be implemented.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Implementation in all regions and countries.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Seven additional full-time equivalent staff members will be required – one at grade P.5 at
headquarters and one at grade P.4 in each of the regions – to ensure the support for the
implementation of the resolution in the regions.
(d) Time frames (indicate broad time frames for implementation of activities).
2011–2015.
1. Resolution WHA64.14 Global health sector strategy on HIV/AIDS, 2011–2015
2. Linkage to programme budget
Strategic objective:
2. To combat HIV/AIDS, tuberculosis and
malaria.
4. To reduce morbidity and mortality and
improve health during key stages of life,
including pregnancy, childbirth, the
neonatal period, childhood and
adolescence, and improve sexual and
reproductive health and promote active and
healthy ageing for all individuals.
The HIV strategy also links with strategic
objectives 6, 7 and 11.
Organization-wide expected result:
All expected results.
All expected results.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The goals of the strategy are consistent with the UNAIDS Strategy 2011–2015 and reaffirm existing
internationally agreed goals:
• to achieve universal access to comprehensive HIV prevention, treatment and care
• to contribute to achieving Millennium Development Goal 6 (Combat HIV/AIDS, malaria and other
diseases) and other health-related Goals (3, 4, 5 and 8) and associated targets.
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The HIV strategy’s four targets for 2015 build on the indicators and targets of the Medium-term strategic
plan 2008–2013. The targets are as follows:
• reduce new infections: reduce by 50% the percentage of young people aged 15–24 years who are
infected (compared with a 2009 baseline)
• eliminate new HIV infections in children: reduce new HIV infections in children by 90%
(compared with a 2009 baseline)
• reduce HIV-related mortality: reduce HIV-related deaths by 25% (compared with a 2009 baseline)
• reduce tuberculosis-related mortality: reduce tuberculosis deaths by 50% (compared with a 2004
baseline).
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
US$ 515 million for the five-year period 2011–2015.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant)
US$ 73 million, of which more than two thirds is expected to be incurred at regional and country
levels.
(c) Is the estimated cost noted in (b) included within the existing approved Programme budget
for the biennium 2010–2011?
Yes.
4. Financial implications
How will the estimated cost noted in 3 (b) be financed (indicate potential sources of funds)?
Funding sources include: assessed contributions; core voluntary contributions; core funding of the
UNAIDS Unified Budget, Results and Accountability Framework; and direct voluntary
contributions from Member States and foundations.
5.
Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
The Secretariat will provide support to implementation of the strategy at all levels of the
Organization and in all regions. A detailed draft operational plan for the next biennium has been
developed, indicating specific outputs at each organizational level and for each region. Particular
attention will be given to ensuring that the Organization has adequate capacity at country level to
support strategy implementation.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
WHO’s HIV programme is currently undergoing a realignment process that aims to identify the
necessary competencies, skills and staffing structure for implementing the strategy. The
realignment is focusing on improving efficiencies within the programme throughout the
Secretariat, including defining a clear division of labour across the three levels of the
Organization. The outcome of the realignment process should be implemented by July 2011 and
it is anticipated that the staffing levels will be sufficient to support implementation of the
strategy. It is anticipated that there may need to be some adjustments in staffing over the fiveyear period to meet changing demands.
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(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Not applicable.
(d) Time frames (indicate broad time frames for implementation of activities)
The strategy will be implemented over a five-year time period. Detailed operational plans will be
developed for each biennium.
1. Resolution WHA64.15 Cholera: mechanisms for control and prevention
2. Linkage to programme budget
Strategic objective:
1. To reduce the health, social and
economic burden of communicable
diseases.
Organization-wide expected result:
1.3
Effective coordination and support provided to
Member States in order to provide access for all
populations to interventions for the prevention, control,
elimination and eradication of neglected tropical
diseases, including zoonotic diseases.
1.9
Effective operations and response by Member
States and the international community to declared
emergency situations due to epidemic and pandemic
prone diseases.
5. To reduce the health consequences of
emergencies, disasters, crises and conflicts,
and minimize their social and economic
impact.
5.4
Coordinated technical support provided to
Member States for communicable disease control in
natural disaster and conflict situations.
8. To promote a healthier environment,
intensify primary prevention and influence
public policies in all sectors so as to
address the root causes of environmental
threats to health.
8.1
Evidence-based assessments made, and norms
and standards formulated and updated on major
environmental hazards to health (e.g. poor air quality,
chemical substances, electromagnetic fields, radon,
poor quality drinking-water and waste-water reuse).
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution is consistent with overall expected results, and with the specific elements noted below.
Baseline: ad hoc support provided to countries and regional offices according to expressed need.
Target: current biennium, develop a medium-term strategy 2011–2016 and a detailed plan of action and
necessary tools; start implementation in three regions; biennium 2012–2013, implement plan in three
regions with three countries in each; biennium 2014–2015, maintain and scale up activities in three
regions and add the three remaining regions.
Indicators:
(a)
information and technical back-up provided to countries affected by outbreaks
(b)
support for each of the participating countries performed as follows:
• national action plan revised and updated; cholera surveillance within integrated diseases
surveillance reviewed in countries
• “hot spots” and trends over time identified
• specific needs for preparedness and prevention activities identified, control activities
implemented and maintained over time (e.g. health education, food safety, water and sanitation,
prepositioning of supplies)
• assessment for vaccine use performed and, if pertinent, plan for introduction elaborated
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• strategy undertaken for training of trainers, multiplication of national workshops and quality
control of capacity-building activities (e.g. in the areas of case management and laboratory
capacities)
• monitoring of performances implemented according to indicators to be identified and developed
(c)
(d)
regular meetings with key stakeholders held to review progress and best practice on various topics
support provided to research activities in risk assessment, vaccine development, and other relevant
issues.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
Total for five years: US$ 20.22 million for staff and activities (programme support costs not included).
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
Staffing: US$ 874 000 at headquarters level and US$ 606 000 at regional level (Regional offices
for Africa, the Americas, and the Eastern Mediterranean).
Activities: US$ 1.24 million, of which 57% will be incurred at regional level.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
The costs associated with outbreaks could to some degree be included in the existing figures for
the approved Programme budget; the extent to which this can be done will depend mainly on the
severity or regularity of outbreaks. It is not expected that the costs associated with preventive
actions could be considered within the current budget ceilings of the strategic objectives
mentioned above.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
A medium-term strategy will be developed and will be used for resource mobilization at
international and country levels.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Global coordination, backstopping and standard-setting at headquarters level; Global Task Force
on Cholera Control functioning with participation from all relevant departments. Activities at
regional and country levels involving a focus during the first biennium on the African Region,
the Region of the Americas and the Eastern Mediterranean Region, scaling up to the South-East
Asia, European and Western Pacific regions during successive bienniums.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Over a five-year period, four additional professional staff will be required at different levels;
additional staff at the general service level will also be needed to support existing staff at
headquarters. At the regional level, for each region a public health specialist or epidemiologist
and a water and sanitation specialist at P.4 level would be required.
(d) Time frames (indicate broad time frames for implementation of activities).
An initial phase of five years.
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1. Resolution WHA64.16 Eradication of dracunculiasis
2. Linkage to programme budget
Strategic objective:
1. To reduce the health, social and
economic burden of communicable
diseases.
Organization-wide expected result:
1.3 Effective coordination and support provided to
Member States in order to provide access for all
populations to interventions for the prevention, control,
elimination and eradication of neglected tropical
diseases, including zoonotic diseases.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution will provide the framework for increasing the number of countries and territories certified
for eradication of dracunculiasis from 187 in 2010 to 193 by 2013.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
US$ 30 million over the envisaged life-cycle of this resolution of five years (2011–2015).
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 12.74 million. The costs will be incurred at headquarters, the regional offices for Africa and
for the Eastern Mediterranean and country offices.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Yes.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Existing extrabudgetary sources.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Headquarters, the regional offices for Africa and for the Eastern Mediterranean and countries
therein.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
Yes.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
None.
(d) Time frames (indicate broad time frames for implementation of activities).
2011–2015.
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1. Resolution WHA64.17 Malaria
2. Linkage to programme budget
Strategic objective:
2. To combat HIV/AIDS, tuberculosis and
malaria.
Organization-wide expected result:
2.1 Guidelines, policy, strategy and other tools
developed for prevention of, and treatment and care for
patients with, HIV/AIDS, tuberculosis and malaria,
including innovative approaches for increasing
coverage of the interventions among poor people, and
hard-to-reach and vulnerable populations.
2.2 Policy and technical support provided to countries
towards expanded gender-sensitive delivery of
prevention, treatment and care interventions for
HIV/AIDS, tuberculosis and malaria, including
integrated training and service delivery; wider serviceprovider networks; and strengthened laboratory
capacities and better linkages with other health
services, such as those for sexual and reproductive
health, maternal, newborn and child health, sexually
transmitted infections, nutrition, drug-dependence
treatment services, respiratory care, neglected diseases
and environmental health.
2.3 Global guidance and technical support provided on
policies and programmes in order to promote equitable
access to essential medicines, diagnostic tools and
health technologies of assured quality for the
prevention and treatment of HIV/AIDS, tuberculosis
and malaria, and their rational use by prescribers and
consumers, and, in order to ensure uninterrupted
supplies of diagnostics, safe blood and blood products,
injections and other essential health technologies and
commodities.
2.4 Global, regional and national systems for
surveillance, evaluation and monitoring strengthened
and expanded to keep track of progress towards targets
and allocation of resources for HIV/AIDS, tuberculosis
and malaria control and to determine the impact of
control efforts and the evolution of drug resistance.
2.5 Political commitment sustained and mobilization
of resources ensured through advocacy and nurturing of
partnerships on HIV/AIDS tuberculosis and malaria at
country, regional and global levels; support provided to
countries as appropriate to develop or strengthen and
implement mechanisms for resource mobilization and
utilization and increase the absorption capacity of
available resources; and engagement of communities
and affected persons increased to maximize the reach
and performance of HIV/AIDS, tuberculosis and
malaria control programmes.
2.6 New knowledge, intervention tools and strategies
developed and validated to meet priority needs for the
prevention and control of HIV/AIDS, tuberculosis and
malaria, with scientists from developing countries
increasingly taking the lead in this research.
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(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution builds on the United Nations General Assembly resolution 55/284, which proclaimed the
period 2001–2010 the Decade to Roll Back Malaria, particularly in Africa; and on resolutions WHA58.2
and WHA60.18, the latter of which resolved that World Malaria Day should be commemorated globally
and annually. The resolution is taking forward the call by the United Nations Secretary-General for
universal coverage with antimalarial interventions; it also provides the framework for achieving the array
of malaria control-related expected results, targets and baseline figures for strategic objective 2 as
outlined in the Medium-term strategic plan 2008–2013. Furthermore, these results, targets and baseline
figures are aligned with the expected results and indicators included in the Roll Back Malaria Global
Malaria Action Plan for the period 2008–2015.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
The life-cyle of the resolution is 2011–2015. The estimated cost of the Secretariat’s responsibility
for coordinating full-scale implementation after 2012 is US$ 500 000.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
A total of US$ 250 000 is needed to enable the secretariat of the Global Malaria Programme to
start working on the provision of support to implementation.
(c) Is the estimated cost noted in (b) included within the existing approved Programme budget
for the biennium 2010–2011?
Eighty per cent of the estimated costs will be covered by the approved Programme budget.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Extrabudgetary sources of funding will be mobilized.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Malaria poses a major threat in all regions, and implementing the resolution will require action at
headquarters, regional offices and in the country offices of the countries in which malaria is
endemic.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No additional positions will need to be established to support implementation.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
See point (b) above.
(d) Time frames (indicate broad time frames for implementation of activities).
The time frame of the resolution is five years.
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1. Resolution WHA64.22 Amendments to the Financial Regulations
2. Linkage to programme budget
Strategic objective:
13. To develop and sustain WHO as a
flexible, learning organization, enabling it
to carry out its mandate more efficiently
and effectively.
Organization-wide expected result:
13.5 Managerial and administrative support services1
necessary for the efficient functioning of the
Organization provided in accordance with service-level
agreements that emphasize quality and responsiveness.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution links with the statutory External Audit of WHO and the certification of the Organization’s
accounts. The intended outcome is an unqualified audit opinion.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
The requirement for the External Auditor to issue a report on the audit of the annual financial
statements is estimated to entail an additional cost of between US$ 100 000 and US$ 200 000 per
biennium. The amount will be known when nominations are received for the post of External
Auditor for the period of two bienniums 2012–2015 early in 2011, and once the External Auditor
has been appointed by the Health Assembly in May 2011.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000, including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
None.
(c) Is the estimated cost noted in (b) included within the existing approved Programme budget
for the biennium 2010–2011?
Not applicable.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Through the regular budget or administrative overheads (programme support costs on voluntary
contributions or the post occupancy charge).
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Implementation activities will principally concern headquarters and the Global Service Centre;
the administered entities – UNAIDS, IARC, the International Computing Centre and the
International Drug Purchase Facility, UNITAID – will also require yearly certification audits of
their accounts. The change in the Financial Regulations should not affect the frequency of
regional audits.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No additional staff will be needed, although the External Auditor will require additional
resources.
1
Includes services in the areas of information technology, human resources, financial resources, logistics and
language services.
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(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
See 5(b) above.
(d) Time frames (indicate broad time frames for implementation).
The first annual certification audit will encompass WHO’s financial statements for 2012.
1. Resolution WHA64.24 Drinking-water, sanitation and health
2. Linkage to programme budget
Strategic objective:
8. To promote a healthier environment,
intensify primary prevention and influence
public policies in all sectors so as to
address the root causes of environmental
threats to health.
Organization-wide expected result:
8.1 Evidence-based assessments made, and norms and
standards formulated and updated on major
environmental hazards to health (e.g., poor air quality,
chemical substances, electromagnetic fields, radon,
poor-quality drinking-water and wastewater reuse).
8.2 Technical support and guidance provided to
Member States for the implementation of primary
prevention interventions that reduce environmental
hazards to health, enhance safety and promote public
health, including in specific settings (e.g. workplaces,
homes or urban settings) and among vulnerable
population groups (e.g. children).
8.4 Guidance, tools and initiatives created in order to
support the health sector in influencing policies in other
sectors to allow policies that improve health, the
environment and safety to be identified and adopted.
8.5 Health-sector leadership enhanced for creating a
healthier environment and changing policies in all
sectors so as to tackle the root causes of environmental
threats to health, through means such as responding to
emerging and re-emerging consequences of
development on environmental health and altered
patterns of consumption and production and to the
damaging effect of evolving technologies.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
Drinking-water, sanitation and health issues cut across the Organization-wide expected results for
strategic objective 8, particularly 8.1 (risk assessment and management guidelines), 8.2 (primary
prevention), 8.4 (intersectoral capacity-building) and 8.5 (monitoring). Strengthened work on the
prevention of water- and sanitation-related disease is consistent with the expected results under the
strategic objective, and implementation of the resolution would be reflected within the indicators and
targets of expected results mentioned above.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
In addition to the current programme, the estimated cost for the period 2012–2013 is US$ 3.94 million.
The estimated cost per biennium on a continuing basis thereafter is about US$ 21.0 million.
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(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
US$ 985 000 (25% of US$ 3.94 million for the last six months of the biennium).
Costs will be incurred at headquarters and at the regional office level in those offices currently
lacking advisors who specialize in water, sanitation and health, namely, the regional offices for
Africa, the Eastern Mediterranean and the Western Pacific.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
No.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Additional voluntary funds are being sought; a number of parties have indicated interest.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Implementation will involve activities at global, regional and country levels. Headquarters will
play a coordination and management role and provide guidance and standard-setting, and will
support the implementation of activities.
The regional offices will support the work in monitoring, water-safety planning, capacity building
and approaches in specific settings.
Projects with a strong country focus will require the involvement of country office staff for
satisfactory implementation.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents – by
levels of the Organization, identifying specific regions where relevant and noting necessary
skills profile).
The following additional staff will be required: a Monitoring Manager at grade P.5; a Technical
Officer at grade P.3 to support UN-Water’s Global Analysis and Assessment of Sanitation and
Drinking-Water; two Technical Officers at grade P.4, one to deal specifically with wastewater
activities, and the other to deal with national health strategies to influence realization of the basic
human right to water and sanitation; and three Regional Advisors on water, sanitation and health at
grade P.4 (one in each of the regional offices for Africa, the Eastern Mediterranean and the
Western Pacific).
(d) Time frames (indicate broad time frames for implementation of activities).
2010–2011. Following a broad consultation on developing a new generation of targets and
indicators for post-2015 water and sanitation monitoring, a number of working groups will be
activated as of 1 July 2011, with an incremental increase of staff to meet additional work
requirements.
2012–2013. The start-up phase and coordination of strategic work should be completed; thereafter
implementation of activities will be on a continuing basis.
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1. Resolution WHA64.27 Child injury prevention
2. Linkage to programme budget
Strategic objective:
3. To prevent and reduce disease,
disability and premature death from
chronic noncommunicable diseases, mental
disorders, violence and injuries and visual
impairment.
Organization-wide expected result:
3.1 Advocacy and support provided to increase
political, financial and technical commitment in
Member States in order to tackle chronic
noncommunicable diseases, mental and behavioural
disorders, violence, injuries and disabilities, together
with visual impairment, including blindness.
3.2 Guidance and support provided to Member States
for the development and implementation of policies,
strategies and regulations in respect of chronic
noncommunicable diseases, mental and neurological
disorders, violence, injuries and disabilities, together
with visual impairment, including blindness.
3.3 Improvements made in Member States’ capacity to
collect, analyse, disseminate and use data on the
magnitude, causes and consequences of chronic
noncommunicable diseases, mental and neurological
disorders, violence, injuries and disabilities, together
with visual impairment, including blindness.
3.5 Guidance and support provided to Member States
for the preparation and implementation of
multisectoral, population-wide programmes to promote
mental health, and to prevent mental and behavioural
disorders, violence and injuries, together with hearing
and visual impairment, including blindness.
3.6 Guidance and support provided to Member States
to improve the ability of their health and social systems
to prevent and manage chronic noncommunicable
diseases, mental and behavioural disorders, violence,
injuries and disabilities, together with visual
impairment, including blindness.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
The resolution provides a framework that will contribute to the achievement of the expected results in
terms of the planned indicators, targets and baseline.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
It is estimated that this resolution will have a life-cycle of 10 years (2011–2021). The estimated
cost of the Secretariat’s activities in support of implementation is US$ 10 million.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
If the resolution is adopted by the Health Assembly in May 2011, the estimated cost during the
biennium 2010–2011 of the relevant Secretariat activities would be US$ 500 000. It would be
incurred at all levels of the Organization.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Yes.
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4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Existing extrabudgetary sources are insufficient to support this cost fully. The Secretariat will
investigate additional sources of funding.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
All WHO regions and countries.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
At headquarters, an additional staff member would be required at P.4 level to coordinate followup activities.
(d) Time frames (indicate broad time frames for implementation of activities).
2011–2021.
1. Resolution WHA64.28 Youth and health risks
2. Linkage to programme budget
Strategic objective:
2. To combat HIV/AIDS, tuberculosis and
malaria.
3. To prevent and reduce disease, disability
and premature death from chronic
noncommunicable diseases, mental disorders,
violence and injuries and visual impairment.
4. To reduce morbidity and mortality and
improve health during key stages of life,
including pregnancy, childbirth, the neonatal
period, childhood and adolescence, and
improve sexual and reproductive health and
promote active and healthy ageing for all
individuals.
6. To promote health and development, and
prevent or reduce risk factors for health
conditions associated with use of tobacco,
alcohol, drugs and other psychoactive
substances, unhealthy diets, physical inactivity
and unsafe sex.
7. To address the underlying social and
economic determinants of health through
policies and programmes that enhance health
equity and integrate pro-poor, genderresponsive, and human rights-based
approaches.
Organization-wide expected result:
2.1. Guidelines, policy, strategy and other tools
developed for prevention of, and treatment and care for
patients with, HIV/AIDS, tuberculosis and malaria,
including innovative approaches for increasing
coverage of the interventions among poor people, and
hard-to-reach and vulnerable populations.
4.6. Technical support provided to Member States for
the implementation of evidence-based policies and
strategies on adolescent health and development, and
for the scaling up of a package of prevention, treatment
and care interventions in accordance with established
standards.
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9. To improve nutrition, food safety and food
security, throughout the life-course, and in
support of public health and sustainable
development.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
This resolution links directly to indicator 4.6.1. In addition, it links to several of the indicators and
targets for strategic objectives as set out in the Medium-term strategic plan 2008–2013 (Amended
(Draft)) (revised version, April 2009).1 The following indicators and targets are concerned: strategic
objective 2, second point; strategic objective 3, all three points; strategic objective 6, all three points;
strategic objective 7, first point; and strategic objective 9, third point.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the resolution (estimated to the nearest US$ 10 000, including staff and
activities).
The lifetime of this resolution is estimated at 10 years (2011–2021). The estimated cost to the
Secretariat for implementation of the resolution over this period at headquarters, the regional
offices and country offices is US$ 105.0 million.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant).
The estimated cost for the Secretariat at all levels during the remainder of the biennium would be
US$ 5.3 million.
(c) Is the estimated cost noted in (b), included within the existing approved Programme budget
for the biennium 2010–2011?
Yes.
4. Financial implications
How will the estimated cost noted in 3(b) be financed (indicate potential sources of funds)?
Existing funds are insufficient to support all these costs. The estimated additional funds needed are
US$ 530 000. The Secretariat will identify alternative sources of funding, to ensure sufficient funding
levels to implement the resolution.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant).
Implementation in all regions and countries.
(b) Can the resolution be implemented by existing staff? If not, please specify in (c) below.
No.
(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile).
Two additional regional staff are required at grade P.4, one in each of the regional offices for Africa
and the Western Pacific to ensure support for implementation of youth health in the region.
(d) Time frames (indicate broad time frames for implementation of activities).
2011–2021.
1
Available online at http://apps.who.int/gb/ebwha/pdf_files/MTSP2009/MTSP3-en.pdf (accessed on 17 May 2011).
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1. Decision WHA64(11) Smallpox eradication: destruction of variola virus stocks
2. Linkage to programme budget
Strategic objective:
Organization-wide expected result:
1. To reduce the health, social and economic 1.7 Member States and the international community
burden of communicable diseases.
equipped to detect, assess, respond to and cope with
major epidemic and pandemic-prone diseases
(e.g. influenza, meningitis, yellow fever, haemorrhagic
fevers, plague and smallpox) through the development
and implementation of tools, methodologies, practices,
networks and partnerships for prevention, detection,
preparedness and intervention.
(Briefly indicate the linkage with expected results, indicators, targets, baseline)
In the decision, the Health Assembly reaffirms the need to reach consensus on a proposed new date for
the destruction of the variola virus stocks, when research outcomes crucial to an improved public health
response to an outbreak so permit. The decision is consistent with the expected result mentioned above
and its indicator.
3. Budgetary implications
(a) Total estimated cost for implementation over the life-cycle of the Secretariat’s activities
requested in the decision (estimated to the nearest US$ 10 000, including staff and activities)
Estimated costs are US$ 1.54 million per year over the lifespan of the decision, which calls for
reporting to the Sixty-seventh World Health Assembly.
(b) Estimated cost for the biennium 2010–2011 (estimated to the nearest US$ 10 000 including
staff and activities, and indicating at which levels of the Organization the costs will be
incurred, identifying specific regions where relevant)
US$ 770 000 at headquarters.
(c) Is the estimated cost noted in (b) included within the existing approved Programme budget
for the biennium 2010–2011?
A figure of US$ 410 000 is already included.
4. Financial implications
How will the estimated cost noted in 3 (b) be financed (indicate potential sources of funds)?
Additional voluntary funds will be sought.
5. Administrative implications
(a) Implementation locales (indicate the levels of the Organization at which the work will be
undertaken, identifying specific regions where relevant)
Headquarters in coordination with the regional offices for the Americas and Europe (repository
inspection visits).
(b) Can the decision be implemented by existing staff? If not, please specify in (c) below
Although additional dedicated technical and specialized logistics expertise will be required, this
can be generated through the redeployment of existing staff.
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(c) Additional staffing requirements (indicate additional required staff – full-time equivalents –
by levels of the Organization, identifying specific regions where relevant and noting
necessary skills profile)
Not applicable.
(d) Time frames (indicate broad time frames for implementation of activities)
Implementation should begin as soon as possible following adoption of the decision. The
decision does not indicate a specific time for the programme to end.
_______________